Endodontic microsurgery sometimes is the only way

Fig. 1

A 28 yers old patient was referred to me due to repeated abscesses on tooth 2.2

Fig. 2

The patient had a sinus tract on 2.2.

The referring dentist asked to make a root canal treatment on tooth 2.1 (negative response to pulp sensitivity test, negative response to electric test) and specification of tooth 2.2

Fig. 3

The pre operative CBCT showed the width of the lesion and the size of the apex

Fig. 4

The access cavity on tooth 2.2 was corrected

Fig. 5

The temporary root canal filling material was removed

Fig. 6

The intra and post operative X-ray show the removal of the canal dressing and the apical plug with MTA.

Fig. 7

72 hours later the MTA hardening was checked and the root canal therapy was finished.

Fig. 8

In a following appointment the root canal treatment of tooth 2.1 was done

Fig. 9

1 month later the patient still had a sinus tract on tooth 2.2 and in the time between the initial therapy and the recall she had multiple abscessed

Fig. 10

It was decided to treat both incisors with a surgical approach. After raising a flap and removing the lesion, methylene bue helped identifying the anatomy.

Fig. 11

Both apices were resected

Fig. 12

After the retro-preparation, a root end filling material was positioned.

Fig. 13

The material set was checked before finishing the therapy

Fig. 14

Post operative X-ray

Fig. 15

4 months follow up

Fig. 16

9 months follow up

Fig. 17

2 years follow up

Fig. 18

4 years follow up