Restorative, Resorptive Retreatment; A Trifecta of Challenges

This wonderful patient presented to our office with pain in the upper left quadrant.

Findings included deep caries in #12 and a host of issues with #14.

I had my reservations about the latter, with findings including the following

• Prior endodontic treatment with asymptomatic apical periodontitis.
• Recurrent caries around the composite, internal resorption in the MB root.
• An untreated MB2 canal .
• Apical pathology associated with the MB root.

Tooth #12 had been treated at the patient’s initial appointment and following resolution of her pain, she decided to roll the dice.

The defective restorations and caries were removed allowing a Soundseal platform to be built.

The MB1, DB and palatal canals were instrumented with .04 taper Endosequence files and a 3D finishing file with chloroform and alcohol to get the walls ready for their date with The Gentlewave Procedure. The previously untreated MB2 canal dividing off the MB1 in the coronal 1/3 was minimally instrumented as I didn’t want to blow out what little dentin remained in the apical ½.

A Gentlewave retreatment cycle was completed, the canals dried and BC Hi-flow and GP used to obturate the canal system. 

The platform was removed and a bonded Luxacore buildup made.

I just had to see how the fill looked in that resorptive defect so took a post-op scan. I’m pleased I was able to tick all the boxes on my mental laundry list going into this one. I still think an implant will ultimately be needed here but perhaps we have bought a few more years for the tooth.

No white smoke just yet!