Options: retreatment versus a surgical approach

Post operative x-ray 9 months after root canals on #27,28 

Original root canal was completed in my office.  Patient was asymptomatic but radiolucent areas were still present.  Patient desired no additional treatment.

1 year post operative x-ray

Same as 9 months

Pre-operative x-ray / 6 year check up

There was a significant change in radial lucency and the tooth was becoming symptomatic.

Immediate post-operative x-ray

Surgical approach was decided for both #27 and #28 as being the most predictable as the original root canal therapy seemed to be adequate.  During the surgery no fractures were found nor any unusual periodontal problems.

15 month check up

Patient is asymptomatic and apical healing is observed around both roots.

Comments:
It is always difficult to decide whether to retreat a root canal or to approach it surgically. If all canals have been found and the obturation seems to be adequate, probably a surgical approach would be more appropriate and more predictable.