Tooth Preservation Through Root-End Surgery in a 15-Year-Old Patient With Refractory Periapical Pathology: A Case Report

Persistent periapical lesions associated with traumatized immature or mature permanent teeth can pose a significant therapeutic challenge when conventional nonsurgical endodontic treatment fails to achieve healing. Surgical endodontic intervention serves as a predictable alternative for preserving natural dentition while eliminating persistent periapical pathology. This case report describes the management of a large refractory periapical lesion associated with maxillary anterior teeth in a 15-year-old patient with a history of dental trauma. Despite five months of intracanal medicament therapy following root canal treatment, the lesion failed to resolve clinically and radiographically. Cone-beam computed tomography (CBCT) revealed a well-defined periapical radiolucency with cortical plate perforation. Surgical management included apicectomy, periapical curettage, laser-assisted debridement, platelet-rich fibrin (PRF)-assisted bone regeneration using sticky bone, and placement of a guided tissue regeneration (GTR) membrane. Histopathological examination confirmed chronic nonspecific inflammation. Clinical and radiographic follow-up demonstrated satisfactory healing and resolution of symptoms. This case highlights the effectiveness of contemporary endodontic microsurgical principles combined with regenerative techniques in preserving natural teeth affected by persistent periapical pathology.