Orthograde Endodontic Retreatment Following Apicoectomy and Resorption of Extruded MTA-A Case Report With 8-Year Follow-Up.

Orthograde retreatment following unsuccessful apicoectomy is a valid treatment option instead of surgical retreatment. This case report details the successful orthograde retreatment of a 34-year-old female patient with persistent symptoms following prior apicoectomy without retrofilling materials and conventional root canal treatment. The mandibular left premolars (#44 and #45) had incomplete apical resections and lacked retrofilling materials, and a nonsurgical approach was chosen due to compromised periodontal conditions. Mineral Trioxide Aggregate (MTA) plugs were placed orthogradely, with unintentional extrusion into the periapical tissues. Despite this, an 8-year follow-up revealed complete resolution of periapical radiolucencies, re-establishment of the lamina dura, and resorption of the extruded MTA. This case highlights the efficacy of orthograde retreatment with MTA plugs in achieving periapical healing, even after failed apicoectomy. Moreover, MTA extrusion may heal satisfactorily without compromising the outcome. Relevant literature is also discussed.