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.