A patient reported to Mountain View Endodontics complaining of significant pain associated with tooth #14. This tooth is the distal abutment for a three-unit FPD. It had been treated endodontically by another clinician 6 months previous to evaluation at Mountain View Endodontics. At the time of the initial endodontic treatment a mostly sub-gingival defect on the DB root was detected when sealer could be seen extruding from the defect on the radiograph.
Radiograph showing defect on DB root marked by extruded sealer
Following completion of RCT, attempts were made by the restorative dentist to seal the defect with restorative material. These attempts were ultimately unsuccessful as the defect was partially covered by gingiva making proper isolation nearly impossble. Significant gingival recession had occurred on the DB root as well and two attempts at soft tissue grafting to cover the exposed root surface were made but to no avail. Upon exam at Mountain View Endodontics the gingival recession had progressed to the point that the defect became fully visible and the gutta percha used in the initial RCT could be visualized.
Pre-op intraoral photograph showing defect and gutta percha within DB root
The patient was presented with the treatment options and elected to pursue root amputation surgery. Due to contamination of the root canal system via exposure to the oral environment through the defect, root canal re-treatment was performed first.
#14 following re-treatment. Sealer can be seen extruding from defect
#14 following resection of DB root
Intraoperative photograph showing resected DB root
Photograph 10 days post-op showing area of resected DB root.
Within two weeks of completion of the procedure the patient was asymptomatic and was pleased to be able to retain #14 and the associated FPD.
