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Heroic Retreatment of a Retreatment: Puzzle Case Part 1

Terry Pannkuk, DDS, MScDDiagnostic Puzzles, Complications: Advanced Management, Fractured Roots, Retreatment Strategies, Dismantling, Gutta Percha Removal, All by Date


An apically propagated crack line was noted in the apical third (June 5, 2014

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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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I would go for obturating the canal with MTA.

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