Apicoectomy-lower left bicuspid with a large lesion near the mental foramen.
A 56-year-old woman presented with a very large asymptomatic lesion associated with tooth #20. The chief complaint was slight numbness radiating to the left side of the chin. Differential diagnosis: 1) Root fracture 2) Failing root canal.
Periodontal probing around tooth #20 was within normal limits. Since the probing was WNL, an apicoectomy was the choice of treatment.
Pre-op of tooth #20 with extensive bone loss
Post-op with super EBA retrograde filling
Post-op of 6-month recall showing healing with total bone fill
Notes: Special care was used in this case to ensure that the mental nerve was not disrupted. The lesion was so large that the mental foramen was not radiographically visible. A biopsy was performed because the lesion was larger than usual. In summary, the biopsy returned with typical pathology associated with a failing root canal. In addition, bone filled in completely around the apex and the initial numbness disappeared within 2 months.