Non-Surgical Endodontic Success in Acute Apical Abscess with Large Periapical Lesion: Is Surgery Always Necessary?

Abstract

Background: The Acute Apical Abscess (AAA) represents a common endodontic emergency. The aim of this case report was to present successful root canal treatment, despite poor and uncertain prognosis.  
Case presentation: Despite the severity of the findings, which required a modification from standard therapeutic approach, the patient underwent immediate root canal treatment. The modified protocol involved the repeated, long-term application of aqueous calcium hydroxide paste, enhanced with methylcellulose. This formulation achieved a rapid pH increase and effective endotoxin neutralization,  initiating bone healing.

Conclusion: This case highlights the clinical significance of long-term calcium hydroxide dressing in the conservative management of AAA with extensive periapical bone resorption. The extended medication protocol induced bone healing, enabling the completion of the root canal treatment and resulting in a favorable long-term therapeutic outcome, contrary to the initial prognosis.