Endodontic Retreatment followed by Periapical Surgery
The patient had been referred to a periodontist who subsequently recommended extraction of tooth 4.6 which had a non-healing lesion following initial endodontic treatment. The patient wanted to retain the tooth and sought a second opinion.
The examination elicited the following results:
- Pulpal Diagnosis of 4.6: Previously treated root canal
- Periapical diagnosis of 4.6: asymptomatic apical periodontitis, chronic apical abscess.
- Differential diagnosis: 4.6: vertical root fracture
The treatment was performed in two steps:
- Retreatement using rotary instrumentation (M- 40, 0.06; D-45, 0.06). Final rinse with 17% EDTA, 2.5% NaOCl, canals dried, obturated with warm vertical condensation of gutta percha and thermaseal.
- Apical surgery. A vertical root fracture was detected in the mesial root and a resection of the root was performed up to the upper level of the fracture. A retroprep was carried out (3 mm), dried, examined and then retrofilled with MTA. The flap was sutured and the sutures were removed 4 days later. Then patient was asymptomatic at subsequent follow-ups.
Having discussed the options for treatment with the patient and stressing the guarded prognosis due to the potential of a vertical root fracture, the patient was still interested in having the treatment as outlined in order to try to retain the tooth.
Being cognisant of your patients’ wishes is essential.