| Patient age | 45 |
| Patient sex | Male |
| Tooth | 16 |
| Chief complaint | My tooth is sore on biting and pressure. From time to time I notice that there is a gum swelling next to the tooth |
| Medical history | Nothing of note |
| Dental history | Patient has had previous root canal treatment over 5 years ago |
| Clinical evaluation | Tooth that is tender to percussion & palpation. Small fluctuant swelling associated with buccal alveolar mucosa |
Pre operative periapical radiograph of the tooth 16
| Diagnosis | Previously endodontically treated tooth with persisting chronic apical periodontitis |
| Treatment planned | Orthograde root canal retreatment, and referral back to general dentist colleague for permanent restoration and crown |
| Alternatives | Tooth extraction and space rehabilitation with dental implant, bridge, or partial denture |
| Prognosis | Fair |
| Treatment | Orthograde root canal retreatment over two visits |
| Chemomechanical debridement | Chemomechanical debridement Removal of previous root filling with ultrasonic instrumentation, retreatment files, and eucalyptus oil. Instrumentation with k-files to produce a reproducible glide path, rotary NiTi to finish the preparation & irrigation with NaOCl. MAF X2 and X3 (ProTaper Next) |
| Dressing | Ca(OH)2 for 4 weeks |
| Obturation | With GP & AH Plus sealer. Warm vertical condensation technique. |
| Orifice barrier | GIC |
Pre obturation periapical radiograph of the tooth 16, checking cone length
| Review | Healing in progress |
| PA demonstrates | Increased bone infill in comparison to post obturation PA taken 6 months prior |
Post obturation periapical radiograph showing obturation to length; right image: Review periapical radiograph showing increased bone infill around the mesiobuccal root
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