Apical Surgery 2

A teenage patient presented with 2 previously traumatized and treated teeth with a large radiolucency at the apex. There was also apical swelling and tenderness along with purulent discharge. You can see on the pre-op film that #7 has significant external resorption. At our initial visit, the existing materials were removed, the canals disinfected and CaOH paste placed in each of the canals. Several weeks later, #7 was obturated with MTA and #8 with gutta percha with a dual-cured resin placed to the DEJ and Heliomolar resin used to restore the access areas. At the 1 year recall exam, no reduction in the size of the apical lesion was seen though the patient remained asymptomatic.

At surgery, a full thickness flap was raised utilizing a sulcular incision and a large cyst-like mass was located and removed. The apex of # 7 was resected but no retroprep or retrofill was needed because the entire canal had previously been obturated with MTA. This is a great advantage of using MTA in an orthograde manner as it greatly reduces the time needed during surgery. The extravated gutta percha and sealer were removed from the apex of #8 but no further resecting was necessary. At the 6 month recall, nearly all of the bone from this very large lesion had regenerated and the patient remained asymptomatic.

Pre-op Post-retreatment Immediate post-sx 6 month recall