Management of Periapical Lesion and Discoloration with Periapical Microsurgery Followed up by Internal-External Bleaching and Direct Composite Restoration: One-Year Clinical Evaluation

Abstract

Background: Endodontic treatment outcomes may change over time. Factors such as compromised coronal seal and inadequate obturation can lead to canal reinfection and often periapical infection, thus developing into periapical lesions. Biofilm occupying the surface of the root tip can cause failure of conventional endodontic treatment or retreatment. Healing is achievable depending on the success of efforts to eradicate the biofilm layer from the site. Tooth discoloration after a root canal treatment can also be concerning, with several causes and treatment options. One of the minimally invasive aesthetic treatment options for discolored anterior teeth is dental bleaching or direct composite veneers. Case Report: A 22-year-old patient experienced pain in the right maxillary lateral and central incisors with a history of trauma at the age of six. Both teeth have undergone root canal treatment at the age of ten years. Clinically, the teeth were discolored with visible old composite restorations. Radiological finding shows radiolucency in the periapical and compromised apical structure. Endodontic retreatment and periapical microsurgery were performed to remove the periapical lesion, followed by internal-external bleaching and direct composite veneer to restore the aesthetics. Results: The procedure was successful, and a one-year follow-up recall revealed bone regeneration around their apices and esthetic outcomes that satisfied the patient. Conclusion: The technique described is an excellent approach in conserving the tooth with periapical lesions and compromised apical structure due to root resorption and internally stained teeth.