COMBINED NON-SURGICAL AND SURGICAL ENDODONTIC CASES

Is this tooth treatable? Is it saveable? Is it even worth trying? Here we present a case where the tooth was supposedly treated endodontically years ago. We suspect that a pulptomy was done at the time of initial treatment. Pulpotomys are usually reserved for immature teeth to save healthy pulp tissue within the roots to encourage continued root development. Often times the root canal space gets obliterated in the process as a protective mechanism to insulate the pulp from further “trauma”. This may become a problem later when the endodontic treatment has to be completed years later, where calcification can block of the canals from being cleansed and shaped to the root terminus. This is the case here, partiularly on the mesial root. Additionally, the lesion associated with the distal root leaves open the possibility of root fracture (none was identified pre-operatively nor intra-operatively). We treated this case both non-surgically with conventional endodontic treatment and surgically. We were unable to negotiate the mesial canals to full length (even though it may appear on several radiographs that this may be possible). Because there is a lesion associated with the mesial root, we know that it will not heal. Should there not be a lesion, we would monitor over time. The decision was made to complete apical surgery of the mesial root. With the combination of non-surgical and surgical endodontic treatment, we are able to provide this patient with a favorable long term prognosis assuming adequate coronal restoration. Happy Monday!