Hopeless Case?

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A 31-year old patient came to me for consultation on teeth #7 and #8. He told me that he had been in an accident as a boy that had resulted in emergency root canal treatment on both teeth. He reported no present pain or discomfort, but a periapical x-ray (Figure 1) revealed poorly filled root canal treatments with a large periapical radiolucency. I gave him a guarded prognosis, explaining that, even after retreatment, he may require apicoectomies in the future.

The patient presented with wide canals and loose gutta-percha points, which had to be removed carefully using a broach. I then took an x-ray (Figure 2) in order to determine how much filling material had been removed. Once I confirmed that the old gutta-percha was out, the way was clear for instrumentation. For obturation (Figures 3A & 3B), I used MTA to fill the apical area during apexification and did the backfill with gutta-percha. This method is strongly recommended, as gutta-percha used alone is likely to get pushed out.

One year and four months later, I performed a follow-up exam to take a look at the apices. Fortunately, the results were positive: x-rays (Figures 4A & 4B) showed that the bone had started to fill in, and the patient was asymptomatic.

Figure 3A Figure 3B Figure 4A
Figure 3A Figure 3B Figure 4A,
Figure 4B
Figure 4B
Figure 1
Figure 2