This was an internal referral from my delightful colleague Alison. The patient reported she had root treatment on her LL1 around 10 years ago. It presented with a buccal sinus tract adjacent to the LL1 and was diagnosed as previously initiated root treatment with a chronic apical abscess with possible internal resorption. A CBCT scan was taken to help assess the restorability of this tooth.
Key findings from CBCT Consultant radiologist’s report by JM Radiology:
- LL1 is mesially rotated
- There is a large, irregularly shaped root canal with fragments of dressing within it.
- It is unclear whether this canal has been partially shaped or if there is a degree of resorption resulting in its widened appearance, if this is resorption the entire length of the root canal is affected.
- There is mild apical resorption of the LL1 resulting in two apical exit points.
- There is a well-defined area of apical radiolucency measuring approximately 5mm (w) x 3mm (d) x 9mm (h).
- There is dehiscence of the labial cortex overlying the root of the LL1 (BIG LESION!)
CBCT assessment confirmed the tooth was restorable however, the patient was consented for the possibility of root-end surgery (RES) should the case fail to heal adequately following an orthograde approach. The treatment was completed over 2 visits and involved an inter-visit dressing with calcium hydroxide which saw full resolution of the buccal sinus tract after a 3-week period. Preparation was carried out using Dentsply’s Wave one gold rotary files up to size medium. It was then obturated with Totalfill BC sealer Hiflow and conform fit GP cones that were customised using a gp cutter to ensure a nice apical fit in view of the apical resorption.
Immediate post-op IOPA
Overall a nice result with this one perhaps a little more sealer extruded than I would ideally like to see, but it shouldn’t pose an issue due to its biocompatibility. A 1-year CBCT review is planned, so I’ll include this once I have it.
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