[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-459512-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-459512-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","cbct-assisted-microsurgical-management-of-dual-periapical-lesions-involving-vital-and-previously-endodontically-treated-maxillary-molars-a-case-report","CBCT-Assisted Microsurgical Management of Dual Periapical Lesions Involving Vital and Previously Endodontically Treated Maxillary Molars - A Case Report","","Cone beam computed tomography-guided retrograde vital pulp therapy (retroVPT) using a bioactive cement can resolve periapical pathology in select multirooted, vital, permanent teeth where one root is affected by adjacent infection. The report describes a rare situation involving two adjacent periapical lesions: one linked to a previously endodontically treated maxillary molar and the other involving a neighboring vital molar, emphasizing conservative, biologically based management.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/cbct-assisted-microsurgical-management-of-dual-periapical-lesions-involving-vital-and-previously-endodontically-treated-maxillary-molars-a-case-report/459512/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/cbct-assisted-microsurgical-management-of-dual-periapical-lesions-involving-vital-and-previously-endodontically-treated-maxillary-molars-a-case-report/459512.png","ImageObject",300,407,{"name":42,"@type":43},"Jake","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",9,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What clinical scenario does the case report describe?","Question",{"text":63,"@type":64},"It presents two adjacent periapical lesions, one associated with a previously endodontically treated maxillary molar and the other involving a neighboring vital molar.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"Why is CBCT important in this presentation?",{"text":68,"@type":64},"CBCT provides high-resolution, three-dimensional imaging to localize lesion morphology, assess root involvement, and clarify spatial relationships for treatment planning.",{"name":70,"@type":61,"acceptedAnswer":71},"What treatment concept is emphasized in managing the lesions?",{"text":72,"@type":64},"The report highlights a conservative, biologically based approach using CBCT-guided retrograde vital pulp therapy and endodontic biomaterials to help preserve pulp vitality and support healing.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},459512,1790793232,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,106,110,115,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":102,"doc_module":4,"doc_module_name":25,"category_name":103,"show_sort_weight":104,"slug":105},6,"Technology",50,"technology",{"id":107,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":108,"slug":109},7,40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":112,"show_sort_weight":113,"slug":114},8,"Research & Report",30,"research-report",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":107,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":102,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144,"preview_page_count":4},962084928904,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Clinical Case Reports  \nCASE REPORT  OPEN ACCESS   \nCBCT-Assisted Microsurgical Management of Dual Periapical Lesions Involving Vital and Previously Endodontically Treated Maxillary Molars: A Case Report  \nSaeed Asgary   \nIranian Centre for Endodontic Research, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran Correspondence: Saeed Asgary ([saasgary@yahoo.com](saasgary@yahoo.com))  \nReceived: 12 June 2025 | Revised: 29 November 2025 | Accepted: 21 December 2025  \nKeywords: calcium derivative | CEM cement | dental radiography | endodontics | microsurgery | mineral trioxide aggregate | vital pulp therapy | volume CT  \n\n| ABSTRACT\u003Cbr>In select multirooted/vital/permanent teeth with periapical pathology in one root due to adjacent infection from neighboring teeth, cone beam computed tomography-guided retrograde vital pulp therapy (retroVPT) with a bioactive cement can resolve the lesion and preserve pulp vitality, offering a conservative, biologically based, and cost-effective alternative to conventional root canal treatment. |  |\n| --- | --- |\n| 1 | Introduction | facilitates more accurate localization of pathology and aids in selecting minimally invasive, targeted interventions [3] . |\n| Periapical lesions are commonly associated with pulpal necrosis |  |\n| and microbial invasion of the root canal system; however, in rare | The success of endodontic surgery is closely linked to the choice |\n| instances, such lesions may also involve adjacent vital teeth. | of root-end filling biomaterials [4, 5] . Calcium-enriched mixture |\n| Diagnosing such complex presentations, particularly when peri- | (CEM), a bio-active/compatible cement, has demonstrated fa- |\n| apical radiolucencies affect multiple roots or teeth with differing | vorable properties such as excellent sealing ability, antibacterial |\n| pulpal statuses, poses significant clinical challenges. Accurate | activity, and the promotion of hard tissue regeneration. When |\n| identification of the source of infection and the extent of periapi- | used in root-end surgery, CEM cement not only ensures a tight |\n| cal pathology is crucial to determine the most appropriate and | apical seal but also enhances periapical healing through cemen- |\n| conservative treatment strategy, particularly when a vital toothis affected by an adjacent lesion [1] . | togenesis and osteogenesis [1, 4] . |\n|  | This case report aims to present a rare clinical scenario involv- |\n| Cone-beam computed tomography (CBCT) has become an in- | ing two adjacent periapical lesions: one associated with a pre- |\n| dispensable tool in endodontic diagnosis and treatment plan- | viously/endodontically treated maxillary molar and the other |\n| ning [2] . Unlike conventional two-dimensional radiography, | involving a neighboring vital molar. It highlights the role of |\n| CBCT offers high-resolution, three-dimensional imaging, en- | CBCT in diagnosis and treatment planning, the clinical applica- |\n| abling clinicians to precisely assess lesion morphology, root | tion of endodontic biomaterials in apical microsurgery, and the |\n| configurations, and anatomical relationships. In complex cases | successful preservation of pulp vitality through surgical root- |\n| with overlapping structures or multi-radicular lesions, CBCT | end management alone (retro-vital pulp therapy; retroVPT), |\n| This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.\u003Cbr>© 2026 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd. |  |\n\nClinical Case Reports, 2026; 14:e71795 1 of 6  \n[https://doi.org/10.1002/ccr3.71795](https://doi.org/10.1002/ccr3.71795)  \noffering a conservative and biologically sound alternative to conventional root canal therapy (RCT) .  \n2 | C","cbCailM8ZBfOnTA5","https://ap.wps.com/l/cbCailM8ZBfOnTA5","pdf",1015964,"English","# Introduction\n# Case History/Examination\n# Diagnostic Imaging\n# Treatment Approach\n# Biomaterials and Microsurgical Management\n# Outcomes and Follow-up","[{\"question\":\"What clinical scenario does the case report describe?\",\"answer\":\"It presents two adjacent periapical lesions, one associated with a previously endodontically treated maxillary molar and the other involving a neighboring vital molar.\"},{\"question\":\"Why is CBCT important in this presentation?\",\"answer\":\"CBCT provides high-resolution, three-dimensional imaging to localize lesion morphology, assess root involvement, and clarify spatial relationships for treatment planning.\"},{\"question\":\"What treatment concept is emphasized in managing the lesions?\",\"answer\":\"The report highlights a conservative, biologically based approach using CBCT-guided retrograde vital pulp therapy and endodontic biomaterials to help preserve pulp vitality and support healing.\"}]","CBCT-Assisted Microsurgical Management of Dual Periapical Lesions Involving Vital and Previously Endodontically Treated Maxillary Molars - A Case Report | PDF",1790756099,15]