Orthograde Root Canal Retreatment

Patient age45
Patient sexMale
Chief complaintMy tooth is sore on biting and pressure. From time to time I notice that there is a gum swelling next to the tooth
Medical historyNothing of note
Dental historyPatient has had previous root canal treatment over 5 years ago
Clinical evaluationTooth that is tender to percussion & palpation. Small fluctuant swelling associated with buccal alveolar mucosa

Image on right: Pre operative periapical radiograph of the tooth 16
DiagnosisPreviously endodontically treated tooth with persisting chronic apical periodontitis
Treatment PlannedOrthograde root canal retreatment, and referral back to general dentist colleague for permanent restoration and crown
AlternativesTooth extraction and space rehabilitation with dental implant, bridge, or partial denture
TreatmentOrthograde root canal retreatment over two visits
Chemomechanical debridementRemoval of previous root filling with ultrasonic instrumentation, retreatment files, and eucalyptus oil. Instrumentation with k-files to produce a reproducible glide path, rotary NiTi to finish the preparation & irrigation with NaOCl. MAF X2 and X3 (ProTaper Next)
DressingCa(OH)2 for 4weeks
ObturationWith GP & AH Plus sealer. Warm vertical condensation technique.
Orifice barrierGIC

Image on right: Pre obturation periapical radiograph of the tooth 16, checking cone length
ReviewHealing in progress
Patient reportsThe tooth has been feeling good since treatment was completed. I can eat on that side again.
PA demonstratesIncreased bone infill in comparison to post obturation PA taken 6 months prior

Left image: Post obturation periapical radiograph showing obturation to length; right image: Review periapical radiograph showing increased bone infill around the mesiobuccal root