Combined Nonsurgical and Surgical Endodontic Management of an Affected Maxillary First Molar In a 14 Year-Old Patient: A Case Report

Objective(s): This report aimed to illustrate the advantage of a hybrid endodontic treatment protocol—integrating orthograde retreatment with subsequent microsurgery—to resolve persistent endodontic failure in permanent molar of a growing patient, thereby preventing premature extraction. Case: A 14-year-old male was referred with a chronic apical abscess and a persistent sinus tract related to the maxillary right first molar (#16). Initial management involved conventional orthograde retreatment; however, the periapical pathology failed to resolve after a three-month observation period. Consequently, endodontic microsurgery was initiated. The surgical protocol incorporated the employment of a high power dental operating microscope, ultrasonic retro-tips, and retrofilling with a bioactive ceramic (Cold Ceramic), supplemented by guided tissue regeneration (GTR). Subsequent clinical and radiographic evaluations at one, six, and 12 months confirmed complete osseous regeneration and resolution of symptoms. Conclusion: For adolescent patients where implants are contraindicated due to incomplete skeletal development, endodontic microsurgery offers a predictable strategy for retaining natural dentition.