Complex retreat in a complex situation
- Dr. Jimmy Chan
- Feb 13
- 2 min read
Updated: Aug 30
Early last year (2023), a patient was referred to me for an infected tooth that was impacting his open heart surgery. While some of your local endodontists can produce excellent results, sometimes it is better to be lucky than good.
The diagnosis for tooth 26 is an asymptomatic periapical abscess, previously root canal-treated and now reinfecting the root canal spaces.
On CBCT analysis, a possible ledge is present in the MB1 canal, a missed MB2 canal with a separate apical foramen, and a short root filling in the DB canal.
My initial impression was that the open heart surgery was of utmost importance compared to his tooth, so I recommended that the tooth be extracted and replaced with an implant after his heart surgery. Extracting the tooth will be a quick and guaranteed solution to resolve the infection. NO TOOTH, NO SOURCE OF INFECTION.
After explaining the possible issues with retreating tooth 26 (unable to bypass the ledge, instrument breaking inside the curve, delaying his heart surgery because of a tooth, which has lifelong consequences to his overall health), this fine young gentleman decided that extraction was not for him. He accepts the result of my treatment of his 26.
The pressure was on as the stakes were high. I planned to bypass the ledge in MB1 and locate MB2 within 30 minutes. If I were not successful in achieving these two objectives, I would then perform endodontic microsurgery to resect the troublesome MB root, removing the curve and ledge.
After 15 minutes...
Fortunately, the Endo Gods were kind to us that day; I successfully bypassed the ledge and negotiated the MB1 and MB2 to the required length. The old root fillings were removed, and the canals were chemo-mechanically prepared to a size 30, 4%. The canals were then medicated with calcium hydroxide. I wrote to his dentist that the infection in tooth 26 has been managed and to refer him back if the tooth flares up or the sinus tract persists within the next 2 weeks. He then flew interstate for his heart operation.
He returned in the 3rd quarter of 2024 and advised me that his heart operation was successful. His tooth is comfortable, and there is no more discharge on his left side.
The tooth is not tender to percussion; the size of the PA lesion has reduced, the draining sinus has healed, and we decided to complete his treatment so that his dentist can provide him with a well-sealing, full cuspal coverage restoration.
Endodontic retreatment can often be successful. However, there are often many considerations and unknowns. Patients need to make informed decisions when deciding to treat or extract.
