LATE RECURRENCE OF PERIAPICAL PATHOSIS FOLLOWING RET: A 9-YEAR FOLLOW-UP CASE

Kılıç Y.

ESE Autumn Meeting 2026, Vilniaus, Litvanya, 23 - 24 Ekim 2026, ss.1, (Özet Bildiri)

  • Yayın Türü: Bildiri / Özet Bildiri
  • Basıldığı Şehir: Vilniaus
  • Basıldığı Ülke: Litvanya
  • Sayfa Sayıları: ss.1
  • Dokuz Eylül Üniversitesi Adresli: Evet

Özet

Aim

            This case presents a recurrence of apical pathology nine years after RET, despite initial radiographic healing and absence of clinical symptoms during follow-up.

Introduction

            Regenerative endodontic treatment (RET) has become a widely accepted approach for immature necrotic teeth, aiming to promote continued root development and healing of apical pathology. Clinical and radiographic healing observed during follow-up periods is generally considered a favorable outcome. However, the long-term stability of periapical healing and surrounding cortical bone remains insufficiently documented.

Case Presentation

            The patient presented to the clinic with a complaint of discoloration in the upper left lateral tooth. Periapical radiography showed that the tooth had an immature (open) apex. Thermal and electrical pulp tests confirmed that the tooth was devitalized.

            After access cavity preparation, RET was planned. Minimal mechanical instrumentation was performed, and the treatment protocol relied on chemical disinfection to preserve dentinal structures. Copious irrigation was performed using sodium hypochlorite (%1), followed by placement of a double antibiotic paste as an intracanal medicament. At the second appointment, the canal was irrigated with EDTA to promote the release of dentinal growth factors and enhance the regenerative microenvironment. Platelet-rich fibrin (PRF), prepared from the patient’s venous blood, was introduced into the root canal space as a biologically active scaffold. Subsequently, a calcium silicate-based material (mineral trioxide aggregate) was placed over the scaffold to approximately 2 mm below the cemento-enamel junction to allow adequate coronal sealing. The tooth was then permanently restored and scheduled for periodic follow-up.

            Radiographic follow-ups obtained in 2018 and 2019 demonstrated progressive periapical healing and reduction of the lesion size. The patient remained asymptomatic and reported no swelling, pain, or infection during the following years. Due to the COVID-19 pandemic, regular follow-up appointments were interrupted. In 2026, the patient returned with a sinus tract associated with the apical region of the same tooth. Radiographic and CBCT examinations revealed recurrent apical pathology accompanied by cortical bone destruction.

            Following the diagnosis in 2026, the coronal restoration was removed. The MTA barrier was carefully retrieved from the canal using ultrasonic devise under an operating microscope. Root canal disinfection was re-established using chemical irrigation protocols, and calcium hydroxide was placed as an intracanal medicament between appointments to further reduce the microbial load. At the subsequent visit, apexification was completed using apical plug material (FKG TotalFill BC RRM). The remaining root canal was obturated using a warm vertical compaction technique. The lesion was surgically debrided and apical surgery was carried out. The patient was scheduled for clinical and radiographic follow-up.

Discussion

RET procedures may provide favorable healing outcomes in immature necrotic teeth; however, radiographic resolution alone may not always represent complete biological stability over the long term. In the present case, early and medium-term follow-up findings suggested successful healing. Nevertheless, CBCT examination performed years later demonstrated recurrence of infection associated with cortical bone integrity loss. This case highlights the importance of long-term follow-up after RET, particularly in teeth presenting with extensive initial lesions. Two-dimensional radiographs may underestimate residual defects, whereas CBCT imaging can provide valuable information regarding cortical bone continuity and lesion diameter. 

Clinical Relevance

            Therefore, long-term assessment of regenerative cases should include not only clinical and radiographic findings, but also evaluation of the stability of the surrounding periapical bone stracture. Cortical bone integrity may play a critical role in preventing recurrence of apical pathology.