Title: Restorative management of maxillary incisors in a post radiotherapy patient
Abstract:
This case report presents the multidisciplinary restorative management of maxillary incisors affected by recurrent apical pathology and aesthetic compromise. A 47-year-old male with a previous diagnosis of p16-positive squamous cell carcinoma of the tongue base, treated with chemoradiotherapy, presented with recurrent apical infection associated with previously root canal-treated maxillary incisors. The potential implications of previous head and neck radiotherapy, including the risk of osteoradionecrosis, were considered throughout treatment planning and delivery. Initial management involved non-surgical endodontic re-treatment of UR1 and UR2; however, ongoing symptoms following this procedure necessitated further investigation. A small cone CBCT identified a buccal lateral canal associated with UR1, accounting for the persistent extra-radicular infection. Surgical endodontic intervention was subsequently undertaken, including apical resection and retrograde MTA placement, resulting in uneventful healing and radiographic evidence of bone infill at one-year review. The restorative rehabilitation phase followed, adopting a staged, minimally invasive approach, progressing from disease resolution to internal and external bleaching prior to planned definitive aesthetic restoration. Care was delivered through multidisciplinary collaboration, integrating restorative, endodontic and surgical input to support safe, predictable, and aesthetic outcomes.
