CASEBOOK

Endodontic Retreatment followed by Periapical Surgery

By Dr. Pavel Cherkas

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:

  1. 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.
  2. 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.

Discussion:

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.

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