A healthy 48-year-old woman presented one year after another clinician performed an apicoectomy on tooth #21 (9). The initial procedure involved two technical errors: the clinician resected the root at an incorrect 45-degree angle and did not place a retrograde root-end filling. The clinician also left the bone defect unfilled. These factors may have contributed to bacterial contamination and recurrent inflammation, accompanied by pain and an active fistula. CBCT imaging showed no visible cortical bone.
During the second surgery, Dr. Dudek discovers soft tissue growing into the bone defect. He prepared the root end of tooth #21 (9) and sealed the canal with MTA. After removing the inflamed tissue, it’s sent it for histopathological examination, which confirmed chronic fibrous inflammation. The bone defect had been left empty, allowing soft tissue to grow into it. To prevent this issue, the defect is filled with 1 cc of Bond Apatite®.
At the six-month follow-up, we observed good bone remodelling and healing. Most importantly, the buccal cortical plate had regenerated, supporting successful healing and bone remodelling in this type of defect.
