Abstract
Traditional endodontic surgery has often faced challenges, particularly in locating and removing broken file fragments within the surgical site near the periapex. A 55-year-old woman presented with pain in her lower left molar, and radiographs showed a fractured file extending beyond the apex of tooth #36. Initial attempts to retrieve the fragment using the braiding technique were unsuccessful after a second instrument separation, prompting the choice of guided microsurgical intervention. Utilizing cone-beam computed tomography and intraoral scans, a surgical template was designed and fabricated to enable precise osteotomy and root-end resection with file retrieval. The procedure included root canal treatment, with the distal canal filled with mineral trioxide aggregate before surgery. This single-step, novel, minimally invasive, guided microsurgery involved guided ostectomy and root-end resection, leading to successful retrieval of the file fragments. The treatment resulted in symptom resolution and uneventful healing.