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Apical periodontitis is the disease of microbial origin. Most of the cases of apical periodontitis responds
positively towards the root canal treatment and lesion heal. But, some cases with extradicular microbial
biofilm do not respond toward treatment. These cases are known as persistent apical periodontitis. The
line of management for cases with persistent apical periodontitis is root canal treatment followed
by surgical management. This report presented to inform the management of surgical repair of tooth
with persistent apical periodontitis due to large apex and crack on the root surface. The lesion has
satisfactory healing and a tooth is function after 2 year and 3 month follow-up.