(TC27) Unmasking Root Canal Failure: A Case of Actinomycosis

Actinomycosis is a polymicrobial gram-positive anaerobic infection, primarily caused by Actinomyces israelii, and presents as chronic suppurative and granulomatous lesions. Although rare in the oral cavity, actinomycosis has been linked to persistent infections associated with infected root canals. This table clinic presents a case report of a patient with chronic, non-healing lesions following non-surgical endodontic therapy on teeth #14 (upper left maxilla) and #30 (lower right mandible). Surgical curettage around tooth #30 revealed actinomycosis upon biopsy. While the traditional management of actinomycosis includes excision of the affected area and extended antibiotic therapy, the AAE Guidance on the Use of Systemic Antibiotics in Endodontics suggests that systemic antibiotics may not be indicated for periapical actinomycosis when infected tissue is adequately curetted during surgery. Interestingly, the surgical biopsy for tooth #14 demonstrated periapical granuloma and abscess without actinomycosis, underscoring that actinomycosis may manifest as a localized infection rather than a widespread oral condition. This case highlights the diagnostic complexities in endodontic infections and supports the need for tailored treatment approaches in managing rare pathogens.