A 42-year-old male presented with a large radiolucency area above tooth #8. Tooth #8 had a previous root canal and an apicoectomy with an amalgam retrograde >12years ago. In addition, the post appears to be long and close to the root end. Periodontal probing was within normal limits. Previous complaints include sinus discomfort with several sinus infections on and off for 10 years. Past recommended treatment by his ENT included sinus surgery. Clinically, there was a sinus tract present and apical palpation sensitivity.
Diagnosis: Periapical abscess and/or cyst as a result of a failing root canal/apicoectomy.
Treatment: Re-treatment of the Apicoectomy with MTA cement retrograde.
X-ray #1: pre-op of tooth #8
X-ray #2: Post-op apicoectomy/retrograde with MTA and Bi-oss bone
X-ray #3: 6 month recall showing bone matrix (Bio-oss) in place and bone filling in. Sinus tract is now gone.
X-ray #4: 2 year recall showing lamina dura formation and total bone fill.
*Notes: Bio-oss bone was placed in the large bone defect to provide a matrix for new bone formation. The lesion was greater than 2 inches in diameter. The bone loss penetrated through the buccal and palatal cortical bone. X-ray #4 shows total healing. If there was leakage or a fracture post-op, the bone matrix (bio-oss) would resorb and the lesion and sinus tract would recur. The patient’s sinus problems resolved within 4 weeks post-op. Sinus surgery was not indicated. An apicoectomy/retrograde with MTA cement solved this problem completely.
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