• Jie Chen, Gaoying Ran, Jingxin Weng, Xiaohao Liu, and Chengjie Xie.
• Department of Periodontics, Stomatological Hospital, School of Stomatology, Southern Medical University, Guangzhou, P. R. China.
• Medicine (Baltimore). 2024 Jul 26; 103 (30): e39073e39073.

RationaleEndodontic surgery, which includes apex resection, retro-fill and some regeneration procedures, is a traditional way to deal with apex fenestration. The endodontic surgery could bring large flap, curtate root length, non-healing mucosa and soft tissue deficiency in the apex area. Other treatment options might be considered according to different etiological factors. Mucogingival surgery provides some ideas in accumulation of soft and hard tissues, especially some unique methods such as "tunnel technique" bringing us a view of minimal invasive surgery approach. A novel surgery named "apical tunnel surgery" was reported here to resolve a root apex exposure with the tunnel-like technique.Patient ConcernsA young female complained about root exposure of upper right anterior tooth without history of trauma or orthodontic treatment.DiagnosisThe intraoral examination revealed a buccal root apex exposure about 3mm in diameter of #12 (FDI teeth numbering system). The tooth was slightly dark with Class 1 mobility. The periodontal situation was good and the occlusion check revealed no traumatic bite on #12. The cone-beam computed tomography (CBCT) showed a bone fenestration from the buccally lower 1/2 root surface to the apex and bone absorption around the apex. It also revealed a bone contour deficiency in #12 area.InterventionsRoot canal treatment, root surface debridement, and soft tissue combined with hard tissue accumulation were carried out in one tunnel-like surgery.OutcomesExamination of 12-month follow-up showed a healed and thickened mucosa in the buccally apical region and CBCT showed the continuous lamina dura occupied the buccal aspect of #12 root apex.LessonsThis new apical tunnel surgery provided soft and hard tissue accumulation in one minimal invasive way in the apex exposure case caused by bone fenestration and thin mucosa.Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.

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