Page 18 - The Beauty and Sorrow in Endodontics-Chapter 1

A 30-year-old male was referred to the clinic for the upper left second
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premolar ( 25) in 1995. Root canal treatment and crown had been completed recently,
however, he still complained of sensitivity to biting. The referring dentist reported
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possible radiolucent lesions around 24 and 26 on the radiograph (Fig 15A). Clinical
examination revealed periodontal disease in quadrant 2. Some recession was present,
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which allowed the author to perform pulp vitality testing on 26, even with a crown in
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place. Electric pulp test of both 24 and 26 were within normal limits. Palpation and
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percussion testing revealed that the discomfort originated from 25. Deconstruction of
the crown and root canal retreatment was recommended to the patient. However, due

to time and financial constraints, he chose to have apical surgery completed instead.
The patient was informed that apical surgery will resolve his discomfort if the problem
originates at the apical ⅓ of the root, but would not help if the problem is at the
coronal or middle ⅓. The patient was willing to take the risk and proceed with apical
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surgery. 2-3mm of the root apex of 25 was removed, ultrasonic preparation of the
retrofill cavity was prepared, and amalgam was used to retrofill in the canal (Fig 15B).
At 6-months post-treatment, the patient reported relief of symptoms and was then able
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to chew using tooth 25 (Fig 15C). In the 1-year post-treatment radiograph, healing of
the lesion is observed, and the lamina dura has reformed (Fig 15D). The patient was
lucky healing was accomplished with apical surgery alone. This case also
demonstrates that removal of the offending source for the apical lesions and overfilling
the canals (either non-surgically or surgically) will successfully resolve the symptoms.

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