Case 50 Implant Vs. Root Canal

Pre-Operative x-ray #3

Tooth number 3 is symptomatic with buccal swelling and an apical lesion is noted. Patient was advised to either have an implant or a root canal. Canals appeared to be sclerosed in the distal buccal and palatal. Options were discussed and patient wanted to save tooth if at all possible. 

Immediate Post-operative x-ray #3

All canals were found and obturated with gutta purcha and sealant. There was no separate MB2. 

6 Month POT x-ray #3

Patient is asymptomatic and healing is complete. 

Comment: Implants are an option if routine root canal therapy fails and retreatment is not a viable solution. If a tooth is not fractured and all canals are found, root canal therapy is very predictably successful. 

Case 49 Apical Surgery with out the benefit of previous Root Canal.

Pre-operative x-ray #28

Patient referred for the treatment of tooth number 28. The buccal tissue was swollen and the patient very symptomatic. The pulp chamber could be seen in the digital picture, but the canal system appeared sclerosed.

X-ray #28

The canal system could not be negotiated too the apex so an alloy was placed and apical surgery scheduled.

Immediate post-operative x-ray #28

Apical surgery completed with a IRM retrofill.

13 months POT x-ray #28

13 months POT. Patient is asymptomatic. Apical healing appears complete.

Comment: Even though a canal system may appear sclerosed it is usually necessary to try and negotiate. Apical surgery is an option if orthograde is unsuccessful. 

Case 48 A Good Use For M.T.A

Pre-operative x-ray #6

Number 6 referred because of a perforation accidentally placed while making a post hole.

Immediate post-operative x-ray #6

The canal space that was accidentally placed was located, cleaned, and dried. Viscostat was placed in the perforation for approximately a minute for the apical bleeding to subside. The M.T.A was packed into the perforation using paper points and a large gutta purcha condenser.  Routine x-rays were taken throughout this procedure to make sure M.T.A was well condensed. 

Comment: M.T.A is available for perforations if there are no periodontal pockets going to the perforated area. If a perforation is treated quickly the chances of success are almost 100%. 

Case 47 Silver Cones Again

Pre-operative x-ray #19

Silver Cones tend to corrode over time. In this particular case tooth #19 was treated decades ago and was now symptomatic. There is bone loss around both roots. Retreatment is probably the only option besides extraction. Even the retreatment prognosis is guarded due to the bone loss already present.

#19

Canals clean. A fourth canal was found in the distal root. The distal buccal and distal lingual canals joined.

Immediate post-operative x-ray #19

 Case completed canals obturated with gutta percha. 

13 month recall x-ray 

Patient is asymptomatic. Healing is incomplete at the mesial apex. The corrosion products from the silver cones probably prevent complete healing, but follow up will continue. 

Comment: Silver cones tend to corrode over time. Retreatment or extraction are ordinarily the two options. At times apical surgery is appropriate but definitely not the first choice.