Early last year, 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 amazing results, sometimes it is better to be lucky than good.
The diagnosis for his tooth 26 is asymptomatic periapical abscess, previously root canal treated and reinfection of the root canal spaces.
On CBCT analysis, there is a possible ledge on the MB1 canal, a missed MB2 canal, which has a separate apical foramina, 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. This will be a quick and guaranteed solution to resolve the infection. NO TOOTH, NO SOURCE OF INFECTION.
After explaining the possible issues with retreating this 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 and he accepts the consequence of treating his 26 by me!
The pressure was on as the stakes were high. I planned to try and bypass the ledge in the MB1, and find the MB2, within 30 minutes, if I was not successful in these 2 objectives, then I would perform endodontic micro-surgery to resect the troublesome MB root removing the curve and ledge away.
After 15 minutes...
Fortunately, the Endo Gods were kind to us that day; I was successful in bypassing the ledge and negotiating the MB1 and MB2 to length. The old root fillings were removed and the canals 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 flared up or the sinus tract persisted within the next 2 weeks. He then flew interstate for his heart operation.
He returned in 3rd quarter of 2024 and advised me that his heart operation was successful. His tooth is comfortable and there was 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 had healed, and we decided to complete his treatment so 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.