[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-447632-105":3,"detail-sidebar-cat-0-en-105":80,"doc-detail-447632-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":73,"head_meta":75,"extra_data":77,"updated_unix":79},105,"en","surgical-management-of-a-lateral-lesion-refractory-to-root-canal-retreatment-caused-by-an-extraradicular-calculus-a-case-report","Surgical management of a lateral lesion refractory to root canal retreatment caused by an extraradicular calculus - A case report","","This article manages a root canal-treated maxillary central incisor with persistent radiographic lateral radiolucency and a sinus tract, despite high-standard root canal retreatment. Indicated endodontic microsurgery included curettage that exposed calculus-like material attached to the outer root surface near a large lateral canal exit. A non-conventional technique avoided root-end resection: calculus removal, apical scaling and smoothing, preparation of retrocavities in lateral and apical foramens, and bioceramic filling. Follow-up showed optimal soft tissue healing and one-year radiographic repair, with the lateral lesion diagnosed as an infected cyst lumen.",{"@graph":14,"@context":72},[15,34,55],{"@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/surgical-management-of-a-lateral-lesion-refractory-to-root-canal-retreatment-caused-by-an-extraradicular-calculus-a-case-report/447632/",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/surgical-management-of-a-lateral-lesion-refractory-to-root-canal-retreatment-caused-by-an-extraradicular-calculus-a-case-report/447632.png","ImageObject",300,407,{"name":42,"@type":43},"\tJames","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-04","2026-09-29",true,{"@type":52,"interactionType":53,"userInteractionCount":26},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"What condition persisted despite high-standard root canal retreatment in the case?","Question",{"text":62,"@type":63},"A radiographic lateral radiolucency and a sinus tract persisted in a root canal-treated maxillary central incisor.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"What key finding was discovered during microsurgery?",{"text":67,"@type":63},"Calculus-like material was attached to the outer root surface around the exit of a large lateral canal.",{"name":69,"@type":60,"acceptedAnswer":70},"What non-conventional treatment approach was used during surgery?",{"text":71,"@type":63},"No root-end resection was performed; the calculus was removed, the apical surface scaled and smoothed, retrocavities prepared, and bioceramic material used to fill them.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},447632,1791092819,{"code":4,"msg":81,"data":82},"success",[83,87,91,95,100,105,109,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":84,"show_sort_weight":85,"slug":86},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":88,"show_sort_weight":89,"slug":90},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":92,"show_sort_weight":93,"slug":94},"Exam",70,"exam",{"id":96,"doc_module":4,"doc_module_name":25,"category_name":97,"show_sort_weight":98,"slug":99},5,"Comic",60,"comic",{"id":101,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},6,"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":107,"slug":108},7,40,"healthcare",{"id":110,"doc_module":4,"doc_module_name":25,"category_name":111,"show_sort_weight":112,"slug":113},8,"Research & Report",30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"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":96,"slug":129},19,"General","general",{"code":4,"msg":81,"data":131},{"doc_id":78,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":106,"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":26,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":115,"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},2336474466412,"https://ap-avatar.wpscdn.com/davatar_155a257f0dc6eb9ab79c44ca47cae57d","Received: 13 May 2022 | Accepted: 14 May 2022  \nDOI: 10.1111/aej.12632  \nCASE REPORT  \nSurgical management of a lateral lesion refractory to root canal retreatment caused by an extraradicular calculus. A case report  \nDomenico Ricucci MD, DDS1  | Irina Milovidova DDS2 |  \nIsabela N. Rôças DDS, MSc, PhD3,4 | José F. Siqueira Jr DDS, MSc, PhD3,4  \n1Private Practice, Italy  \n2Private Practice, Irkutsk, Russian Federation  \n3Department of Endodontics, Faculty of Dentistry, Grande Rio University, Rio de Janeiro, Brazil  \n4Department of Endodontics and Dental Research, Iguaçu University (UNIG), Nova Iguaçu, Brazil  \nCorrespondence  \nDomenico Ricucci, Piazza Calvario, 7, 87022 Cetraro (CS), Italy. [Email:](Email: dricucci@libero.it)[ dricucci@libero.it](Email: dricucci@libero.it)  \nAbstract  \nThis article describes the management of a root canal-treated maxillary central incisor displaying a radiographic lateral radiolucency and a sinus tract that persisted irrespective of root canal retreatment following high standards. Endodontic microsurgery was indicated and curettage of the pathologic tissue revealed a calculus-like material attached to the outer root surface around the exit of a large lateral canal. A non-conventional approach was chosen: No root-end resection was conducted. Instead, the calculus was removed and the apical surface was scaled and smoothed, conserving the apical structure. Retrocavities were prepared in both lateral and apical foramens and filled with a bioceramic material. Follow-up examination showed optimal soft tissue healing. One-year follow-up of radiographs revealed healing of the lateral lesion. The lesion was diagnosed as a cyst, with an infected lumen. An exuberant calculus-like material attached to the external root surface was the most likely cause of the recalcitrant lateral periradicular lesion.  \nKEYWORDS  \napical microsurgery, bacterial biofilm, bioceramic materials, endodontic retreatment, extraradicular infection, lateral canal, periapical calculus, root canal treatment failure  \nINTRODUCTION  \nApical periodontitis is caused by bacteria that infect the root canal system [1, 2]. Like virtually all natural environmental sites [3], bacteria colonise and live in the necrotic root canal space as members of metabolically integrated biofilm communities attached to the dentinal wall surfaces [4–6] . The high prevalence of bacterial biofilms observed in both untreated and treated teeth displaying apical periodontitis allowed the conclusion that apical periodontitis can be included in the set of biofilm-induced diseases [4] .  \nBacteria are usually located within the boundaries of the root canal system, but occasionally they can trespass these limits, giving rise to a condition known as extraradicular infection [7] . Apart from the acute apical abscess,  \nwhich is the most common, though transient, form of extraradicular infection [8], there are some specific conditions in which bacteria are established in the periapical tissues. One is represented by the formation of cohesive actinomycotic-like colonies within the body of the inflammatory lesion [9–11]; the other consists of biofilms  \nattached to the external radicular surface [4, 12, 13] .  \nLateral canals, as well as apical ramifications, are potential pathways through which bacteria and/or their metabolic products may reach the periodontal ligament and cause a lateral periodontitis lesion [14] . In teeth with lateral periradicular lesions of endodontic origin, the tissue content of the associated lateral canal can be entirely vital, vital to some extent or entirely necrotic [15] . In cases with a vital tissue in the lateral canal, bacterial virulence  \nAustEndodJ. 2023;49:183–[191. wileyonlinelibrary.com/journal/aej](191. wileyonlinelibrary.com/journal/aej) © 2022 Australian Society of Endodontology Inc. | 183  \nfactors such as enzymes, exotoxins and metabolites can diffuse from the necrotic and infected main canal through the vital and inflamed conn","cbCailKmRzkliu7c","https://ap.wps.com/l/cbCailKmRzkliu7c","pdf",3702245,"English","# Abstract\n# Introduction\n# Case report","[{\"question\":\"What condition persisted despite high-standard root canal retreatment in the case?\",\"answer\":\"A radiographic lateral radiolucency and a sinus tract persisted in a root canal-treated maxillary central incisor.\"},{\"question\":\"What key finding was discovered during microsurgery?\",\"answer\":\"Calculus-like material was attached to the outer root surface around the exit of a large lateral canal.\"},{\"question\":\"What non-conventional treatment approach was used during surgery?\",\"answer\":\"No root-end resection was performed; the calculus was removed, the apical surface scaled and smoothed, retrocavities prepared, and bioceramic material used to fill them.\"}]","Surgical management of a lateral lesion refractory to root canal retreatment caused by an extraradicular calculus - A case report | PDF",1790721984,23]