LAUSR

Endodontic microsurgery on the palatal root of maxillary molars presents a clinical challenge due to the root position and approximation from the maxillary sinus floor. Attempting a buccal or a palatal approach to address the root is associated with limited accessibility and visibility, as well as the risk of injury to the maxillary sinus membrane and/or the greater palatine nerves and vessels. If all the maxillary molar roots require surgical intervention, two flaps may even be needed, which can make the procedure technically more difficult and lengthier. This case report aims to present two clinical cases, in which apicoectomy was needed on the palatal roots of maxillary molars. The treatment includes selective non-surgical retreatment of the palatal root and obturation using a root repair material followed by a surgical intervention from a buccal approach to treat the buccal roots, sinus lift using Piezosurgery, and root resection of the palatal root. The approach was successful in both cases without any untoward events. We monitored the radiographic changes using Cone Beam Computed tomography (CBCT) immediately after the surgery and at multiple follow-up appointments. The CBCT images revealed healing of the periapical disease around all the roots up to 14 and 24 months and apical repositioning of the maxillary sinus floor.