Cirurgia parendodôntica em molar superior com perfuração radicular e proximidade ao seio maxilar: relato de caso clínico

Abstract

INTRODUCTION: Parendodontic surgery is indicated in cases of endodontic treatment failure, root perforations, and persistent periapical lesions, especially when conventional retreatment is not feasible. Advances such as cone-beam computed tomography (CBCT), optical magnification, and calcium silicate–based biomaterials have increased the predictability and conservative nature of this approach, particularly in anatomically complex regions, such as maxillary molars in close proximity to the maxillary sinus. OBJECTIVE: To report a clinical case of parendodontic surgery in a maxillary molar with a fractured instrument and perforation in the mesiobuccal root, highlighting three-dimensional planning and the surgical approach. CASE REPORT: A 65-year-old patient presented with pain in a maxillary molar, with a fractured file and perforation in the mesiobuccal root in close proximity to the maxillary sinus, making orthograde retreatment unfeasible. The canal was filled with bioceramic cement, followed by paraendodontic surgery with apicoectomy, without retrograde filling, associated with the use of bone grafting combined with a membrane in larger defects. Follow-up showed lesion regression, bone healing, and preservation of the maxillary sinus, indicating treatment success. FINAL CONSIDERATIONS: The integration of advanced imaging diagnostics, the use of modern biomaterials, and minimally invasive surgical techniques significantly contributes to the success of parendodontic surgery.