Heroic Retreatment of a Retreatment: Puzzle Case Part 1

Terry Pannkuk, DDS, MScD Complications: Advanced Management, Fractured Roots, Retreatment Strategies, Dismantling, Gutta Percha Removal

You make the call at the surprise decision point!

Patient: 52 year-old male in excellent health

Chief Complaint: Patient reported a bump on the gums above his front upper tooth

Dental History: Patient reported a history of prior orthodontics as a child and previous endodontic treatment performed on the maxillary left and right central incisors in 1970 (teeth #’s 8 and 9). Surgical endodontic treatment had been performed years ago after a recurrent infection associated with the maxillary left central incisor (tooth #9)

Significant Findings (teeth #’s 8 and 9): Percussion and palpation tests were within normal limits for both teeth. Periodontal probing depths were within normal limits for both teeth. A fistula with drainage was noted at the apical extent of the attached gingiva opposite tooth #9. Radiographic findings revealed slight PDL space widening with a slightly short root canal filling associated with tooth #8. Tooth #9 revealed a diffuse periapical radiolucency with a root filling filled 2-3 mm short of the radiographic terminus and a suspected “blunderbuss” apex.

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1 comment

Commenting Guidelines Please make scholarly cited references or expert opinions suitable for publication. The comments can either be "pro" or "con" with references to the treatment philosophy. We encourage objectivity and detailed demonstration of knowledge/literature.
Harsh Amlani commented 8 years ago.

I would go for obturating the canal with MTA.

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