One-year follow-up of endodontic retreatment in a patient with severe Hemophilia A

Aim: To describe the clinical management of a patient diagnosed with severe Hemophilia A presenting an endodontically treated tooth (ETT) with a persistent periapical radiolucent lesion. Summary: This case report has been written according to Preferred Reporting Items for Case reports in Endodontics (PRICE) 2020 guidelines. Inherited bleeding disorders (IBDs) are a heterogeneous group of genetic conditions in which missing or defective clotting factors prevent normal blood clotting from occurring. Among those conditions, Hemophilia A (deficiency of factor VIII) is the most prevalent, representing about 85% of all inherited bleeding disorders. A 21-years- old male was referred to our service to retreat a left mandibular first molar. At clinical examination, the ETT showed signs of persistent symptomatic apical periodontitis, confirmed by the radiographic exam. After reviewing the risks and benefits, written informed consent was obtained from the patient, and then, non- surgical root canal retreatment was performed on the tooth under dental operating microscopy. Reciproc R25 NiTi file was used to remove the previous fillings and reprepare the root canal system, and Bio-C Sealer was the chosen sealer to obturate the root canals. The entire retreatment procedure was performed in a single-visit. At the subsequent follow- up visits one year later, the periapical radiograph suggests a successful outcome with periapical repair, a substantial improvement in bone density, and the patient reported that he was free of symptoms and using the tooth as usual. Key learning points Although no complications or excessive bleeding was observed, proper multidisciplinary planning must be carried when treating patients with inherited bleeding disorders. All efforts should be made to avoid intraoperative complications or multiple sessions that also require multiple clotting factor infusions, and further clinical investigations should focus on the need for prophylactic protocols in order to safely perform endodontic treatment on patients diagnosed with different severity levels of IBDs.