AN UNUSUAL ‘POST’ REMOVAL
Apicoectomy can be a highly predictable treatment option for patients with failing endodontic therapy. Modern microscurgery involves not only root resection, but also retropreparation using ultrasonics and retrofil using bioceramic materials like MTA. Without these two key factors, treatment success drops from ~87% to nearly 60% and is the reason apicoectomy tends to have a “50/50” connotation with some oral surgeon offices. The following is a great case to demonstrate the possibilities in modern endo! Pre-operatively you can note that the ‘post’ (silver point) goes to the apex and CBCT showed a corresponding lesion. Placing bioceramics on top of the silver point, or just resecting the silver point, still leaves plenty of room for bacterial leakage since the bioceramic can’t achieve an adequate thickness to provide an apical seal. In this case, we removed the silver point through the apex of the tooth so that bioceramics could be injected and condensed 1/2 way up the root. This retrofil thickness can provide a highly predictable outcome for this patient who might have otherwise needed extraction of a pier abutment on a 7-unit FPD with mesial cantilever.