Case of Complex Diagnosis
Sinus tract is tracing to #19 but it is testing vital with cold. The axial view of CBCT showed the lesion is extending from tooth #18 to tooth #19 and the fact that this tooth is not centered in the lesion justified the positive respond to the cold test. Therefore decided to only retreat #18.
It has been treated and after one year surviving without any symptom.
Teeth #8 and #9 has been avulsed. #9 was managed and #8 was observed.
One year recall showed the external resorption on #9 has been stopped and now #8 needed RCT.
Root End Micro Surgery
Tooth #19 presented with RCT and sensitivity to percussion. The pushed out separated instrument was deemed the source of the complaint. The root end micro surgery was performed and in one year recall patient had no symptom and the X-ray showed satisfactory healing.
Teeth #2 and #3 both had RCT and sensitive to percussion and palpation. The CBCT showed involvement of multiple roots from both teeth. Selective re-treatment improved the patients symptoms but not fully resolved.
Root end micro surgery with buccal and palatal approach was performed and fully resolved the symptoms and the recall X-ray shows satisfactory healing of the lesion.
RCT was done a year ago by another endodontist and the lesion has not been healed. The proximity of the mental foramen to the apex made the root end surgery contraindicated. The intentional reimplantation was performed and the recall X-ray shows satisfactory healing.