# Endodontic Surgery Management of a Large Periradicular Actinomycosis Lesion

## TL;DR

A rare case of actinomycosis infection in a tooth was successfully treated with endodontic surgery after failing conventional treatments.

## Contribution

Highlights the rare occurrence of apical actinomycosis and its management through endodontic surgery.

## Key findings

- Chronic apical periodontitis in Tooth #21 was suspected but did not respond to conventional treatment.
- Histopathological analysis confirmed actinomycotic infection, requiring endodontic surgery for resolution.

## Abstract

A 22-year-old female patient consulted the Odontology Department of the Mohammed V Military Hospital in Rabat, Morocco, for a recurrent abscess in relation to the left maxillary central incisor (#21). The dental history of the tooth began with necrosis following trauma a few years before. A conventional endodontic root canal treatment was performed, but several infectious episodes occurred, treated only with antibiotics. The radiographic examination showed an adequate root filling and a large apical lesion in Tooth #21. Tooth #21 was diagnosed as chronic apical periodontitis. After orthograde retreatment, clinical signs have not resolved, and the patient has consulted for a recurrent abscess. Given this atypical clinical situation, an extraradicular infection was suspected and the decision for endodontic surgery was made. The histopathological diagnosis revealed actinomycotic infection. The aim of this case report is to draw practitioners' attention to this rare infectious etiology, which does not respond to conventional endodontic treatment, and to expose the diagnostic and therapeutic approach required to treat apical actinomycosis.