A patient came to the clinic complaining of pain when pressing on the anterior lower gingival region. On clinical examination, pain on percussion in the region 41 to 32. Radiographic and tomographic exam revealed a radiolucent area in the apical region of tooth 31, besides a fixed prosthesis and a large intraradicular retainer. We then opted for paraendodontic surgery. Apicectomy was performed, retro preparation with ultrasound and retro filling with bioceramic cement.