Non-Surgical Management of Apical Fenestration Associated with Apical Periodontitis in a Tooth with an Open Apex: A Case Report.

Background and Clinical significance: Apical fenestration is a rarely reported clinical finding that may be associated with apical periodontitis. However, its diagnosis can often be complicated by overlapping clinical and radiographic features. While management traditionally involves a combination of endodontic and surgical interventions, there is limited documentation regarding successful outcomes achieved through non-surgical treatment alone. Therefore, further reporting and investigation of such cases are warranted to enhance clinical understanding and inform decision-making. Case Presentation: This case report describes the non-surgical management of a 20-year-old patient presenting with symptomatic apical periodontitis and a labial apical fenestration in a previously treated maxillary left central incisor (tooth #21) exhibiting an open apex. Diagnosis was confirmed using cone-beam computed tomography (CBCT), which revealed a bone defect in the facial cortical plate. The treatment protocol involved conservative canal debridement, intracanal placement of calcium hydroxide, and final obturation using an apical plug of calcium silicate-based hydraulic cement (CSBHC) and the monoblock technique. Over a follow-up period of two years and eight months, clinical and radiographic assessments demonstrated resolution of symptoms, healing of the sinus tract, and complete regeneration of the buccal cortical bone.

Conclusions

This case highlights the potential for complete healing of apical fenestration associated with apical periodontitis in an open apex tooth through non-surgical endodontic treatment alone.