Orthograde Root Canal Retreatment

Patient age 45
Patient sex Male
Tooth 16
Chief complaint My tooth is sore on biting and pressure. From time to time I notice that there is a gum swelling next to the tooth
Medical history Nothing of note
Dental history Patient has had previous root canal treatment over 5 years ago
Clinical evaluation Tooth 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
Diagnosis Previously endodontically treated tooth with persisting chronic apical periodontitis
Treatment Planned Orthograde root canal retreatment, and referral back to general dentist colleague for permanent restoration and crown
Alternatives Tooth extraction and space rehabilitation with dental implant, bridge, or partial denture
Prognosis Fair
Treatment Orthograde root canal retreatment over two visits
Chemomechanical debridement Removal 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)
Dressing Ca(OH)2 for 4weeks
Obturation With GP & AH Plus sealer. Warm vertical condensation technique.
Orifice barrier GIC

Image on right: Pre obturation periapical radiograph of the tooth 16, checking cone length
Review Healing in progress
Patient reports The tooth has been feeling good since treatment was completed. I can eat on that side again.
PA demonstrates Increased 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