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ePaper created 2017-03-17, 10:24:23 | version 1.38.0
COMBINED SURGICAL AND NONSURGICAL — endodontic retreatment for the management of an unusual clinical case Dr. Francesco Maggiore, Italy Introduction The ultimate goal of endodontics is to treat or to prevent endodontic pathology by properly cleaning, disinfecting and fill- ing the complete root canal system. This is generally achieved by one of the three major endodontic therapies: 1. Orthograde or conventional endodon- tic treatment is delivered when the tooth presents with pulpal or periapical pathol- ogy and has not received any previous endodontic therapy. 2. Nonsurgical endodontic retreatment is delivered when the tooth has been treat- ed previously, but the periapical patholo- gy persisted or reoccurred after a period and the tooth is accessible using a coronal approach. 3. Surgical endodontic retreatment is generally performed when the endodon- tically treated tooth still presents with a periapical pathology, but a coronal ap- proach is not feasible because of pros- thetic restorations or if it is not able to resolve the periapical problem. In these cases, the incision of a surgical flap and retrograde management of the apical third of the root is required. Even though the majority of endodontic cases are treated using one of the above-mentioned modalities, clinical sit- uations arise in which the orthograde ap- proach or the surgical approach alone is not able to clean and disinfect the com- plete root canal system and to provide a hermetic apical seal. In these cases, a combined orthograde and surgical ap- proach is required. Very often, these are cases in which the tooth received previous endodontic treatment that did not resolve the endodontic pathology and caused morphological alteration of the apical third of the root, requiring surgical inter- vention to be properly managed. The present article reports on an unusual clin- ical case treated by nonsurgical endodon- tic retreatment followed by surgical end- odontic retreatment in order to remove a foreign metallic object from the peri- apical tissue and to properly treat the apical third of the root. The object was afterward identified as a wrongly posi- tioned endosseous implant that was re- sponsible for the symptomatology. Case report A 57-year-old female patient was referred to our clinic in order to evaluate a symp- tomatic tooth #23. The patient had spon- taneous pain in the left upper jaw, in the vestibule of the tooth #23. At the clinical examination, the tooth presented with a composite restoration, was negative to the vitality test, and was sensitive to per- cussion and palpation. The clinical exam- ination revealed the presence of a scar in the vestibule of the left upper jaw due to a previous surgery (Fig. 1). The radio- graphic examination showed previous endodontic treatment of tooth #23, a shortening of the root and an apical ra- diolucency associated with a suspected gutta-percha cone or a radiopaque post beyond the apical third of the root (Fig. 2). The anamnestic data were noncontribu- tory. On the basis of the clinical and ra- diographic examination, a diagnosis of previous endodontic treatment with a symptomatic periapical lesion was made. Since the material in the apical third was thought to be a gutta-percha cone of larg- er size, and assuming it would be possible to remove it with an orthograde approach, 38 — issue 2017 Endodontics Article