Bai Liyun, Hu Na, Yang Qin, Pu Dongquan, Feng Xiaoqian, Yue Yiyun, Xiao Weiwei, Liu Rui, Liu Li, Zhou Xia
Department of Stomatology, Daping Hospital, Army Medical University, Chongqing, 400042, People's Republic of China.
The Affiliated Stomatological Hospital of Chongqing Medical University, Chongqing, 401147, China.
J Med Case Rep. 2025 May 23;19(1):249. doi: 10.1186/s13256-025-05234-x.
The destruction of tooth apical bone mainly comes from odontogenic apical cysts caused by pulp necrosis, chronic inflammation, or trauma. Some affected teeth can be cured by modern root canal treatment or non-surgical retreatment, but some affected teeth do not heal after treatment. Apical surgery should be considered when root canal therapy has failed, root canal retreatment through the crown channel is difficult, or true cysts are present. This article explores the use of microapical surgery to treat a periapical cyst caused by apical ramification, emphasizing a minimal surgical approach for this lesion.
A 47-year-old female (Han nationality) presented with a chief complaint of recurrent buccal mucosal fistula in their maxillary posterior teeth for 1 year. Clinical examination revealed a porcelain-fused-metal crown of the maxilla of the left second premolar (tooth 25) and buccal mucosa fistula. X-ray assessment showed a high-density shadow in the root canal and low-density transmission from the root apex to the middle third of distal root surface. Microscopic apical surgery was performed under local anesthesia. The apical ramification was exposed and a root apex of 3 mm was cut off. Then the apical foramen of buccal root canal, palatal root canal, and apical ramification were filled retrogradely with mineral trioxide aggregate, and finally sewn up. Follow-up X-ray at postoperative 12 months and 24 months showed that the bone density of the root apex and distal root surface was higher compared with the values measured immediately after operation. There were no clinical symptoms, and normal mucosa.
The patient presented with a recurrent buccal mucosal fistula in the maxillary left second premolar. Microscopic apical surgery was performed under local anesthesia. After minimally invasive surgery, apical resection, inverted preparation, and mineral trioxide aggregate treatment, at postoperative 24 months, the outcome was satisfactory, with recovered apical bone, normal mucosa, and no clinical symptoms. For periapical cysts, X-ray and cone-beam computed tomography images should be read carefully before the operation. The semicircular low-density transmission image around the apical sidewall indicates the apical ramification, and that root canal treatment or microapical surgery should be performed. The operating microscope enhances visibility and provides the surgeon with a better understanding of canal anatomy, a better surgical view, and the ability to undertake more complex but predictable apical resection techniques.
根尖周骨破坏主要源于牙髓坏死、慢性炎症或外伤引起的牙源性根尖囊肿。一些患牙可通过现代根管治疗或非手术再治疗治愈，但部分患牙治疗后无法愈合。当根管治疗失败、通过冠部通道进行根管再治疗困难或存在真性囊肿时，应考虑根尖手术。本文探讨使用显微根尖手术治疗根尖分歧引起的根尖囊肿，强调针对该病变采用最小化手术方法。
一名47岁女性（汉族），主诉上颌后牙颊侧黏膜反复瘘管1年。临床检查发现左上颌第二前磨牙（25号牙）为烤瓷熔附金属冠，颊侧黏膜有瘘管。X线评估显示根管内高密度影，根尖至远中根面中1/3处低密度透射影。在局部麻醉下进行显微根尖手术。暴露根尖分歧，切除3mm根尖。然后用三氧化矿物凝聚体对颊侧根管、腭侧根管根尖孔及根尖分歧进行倒充填，最后缝合。术后12个月和24个月的随访X线显示，根尖及远中根面骨密度较术后即刻测量值更高。无临床症状，黏膜正常。
该患者上颌左第二前磨牙出现反复颊侧黏膜瘘管。在局部麻醉下进行显微根尖手术。经过微创手术、根尖切除、倒预备及三氧化矿物凝聚体治疗，术后24个月，效果满意，根尖骨恢复，黏膜正常，无临床症状。对于根尖囊肿，术前应仔细阅读X线和锥形束计算机断层扫描图像。根尖侧壁周围半圆形低密度透射影像提示根尖分歧，应进行根管治疗或显微根尖手术。手术显微镜提高了可视性，使术者更好地了解根管解剖结构、获得更好的手术视野，并能够进行更复杂但可预测的根尖切除技术。
