Abstract

Background: The success rate of contemporary apical surgery is high after the introduction of magnification, ultrasonics, and bioceramic materials. Persistent apical periodontitis following surgical treatment is usually related to the failure in eliminating or at least sealing residual bacteria occurring in the root canal system.

Case Description: This article reports on a clinical case of postsurgical apical periodontitis associated with a mandibular molar exhibiting failing root-end filling with a bioceramic (calcium silicate-based) material. The tooth had been subjected to retreatment and later to apical surgery because of persistent apical periodontitis. After a period in that the lesions had apparently healed based on radiographs, the appearance of a sinus tract and the observation of recurrence of the apical periodontitis lesions on both roots as shown by CBCT led to indication for a new surgery. Surgery revealed a fracture in the mesial root. The tooth was extracted and the distal root with the associated apical periodontitis lesion was processed for histobacteriological analysis of the possible etiology of postsurgical disease. A residual bacterial infection, favoured by substandard technical surgical issues, was the most likely cause of the periapical inflammation. It was also apparent that root end filling was not placed along the long axis of canal to depth of at least 3mm, and the bioceramic material used as root-end filling allowed bacteria to leak across and grow on it forming biofilm structures.

Conclusion: The observation of bacteria leaking through the bioceramic material used as root-end filling questions the reported antimicrobial properties of bioceramic materials.

Introduction

The success rate of apical surgery is relatively high, especially after the introduction of magnification, ultrasonics for root-end resection and preparation, and bioceramic (also referred to as hydraulic, calcium silicate-based, or MTA-based) root-end filling materials (Rubinstein & Kim 2002, Setzer et al. 2010, Tsesis et al. 2013, von Arx et al. 2019).

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