Patient came to the office with a history of consultations with other colleagues for access surgery on a tooth 43, without any symptoms or signs. Radiographic examination suggested bilateral perforation, absence of the root canal image and diffuse periapical radiolucent image. The first attempt to locate the root canal was unsuccessful, and because of the wear already performed, guided access surgery was discarded. We then planned para-endodontic surgery with apicectomy, preparation and retrograde filling and closing of the perforation, both with bioceramic repair cement. The retro preparation was very difficult due to the absence of a canal. Therefore, only retro obturation was performed.