Endodontic Management of Apical Periodontitis in a Liver Transplant Candidate: A Case Report with CBCT-based Volumetric Monitoring

Abstract

Background: Managing apical periodontitis in a liver transplant candidate requires close coordination because advanced cirrhosis, coagulation abnormalities, and metabolic comorbidities may complicate dental treatment. Case Presentation: A 53-year-old man with alcohol-associated liver cirrhosis, type 2 diabetes mellitus, hypertension, and hypothyroidism was referred for elimination of oral infectious foci before transplantation. Teeth #14 and #21 were diagnosed with pulp necrosis and apical periodontitis, while tooth #22 had previously been treated and showed asymptomatic apical periodontitis. Following multidisciplinary assessment, nonsurgical root canal treatment was performed for teeth #14 and #21, and nonsurgical retreatment was performed for tooth #22. The protocol included chemomechanical preparation, sodium hypochlorite irrigation, calcium hydroxide intracanal medication, and adjunctive antimicrobial photodynamic therapy. Clinical status and periapical healing were assessed over 12 months using limited-field cone-beam computed tomography and manual volumetric segmentation. Results: All treated teeth remained asymptomatic and functional. Periapical lesion volumes changed from 0.41 to 0.00 mm³ for tooth #14, 16.65 to 10.82 mm³ for tooth #21, and 8.17 to 1.18 mm³ for tooth #22, corresponding to reductions of 100.0%, 35.0%, and 85.6%, respectively. No treatment-related adverse events were observed. Conclusion: This case demonstrates the clinical feasibility of coordinated nonsurgical endodontic care and CBCT-based volumetric monitoring in a medically complex liver transplant candidate. The findings are limited to a single case and do not establish the efficacy of adjunctive aPDT or the superiority of CBCT monitoring.