Apicoectomy-Lower Left Bicuspid

A 56-year-old woman presented with a very large asymptomatic lesion associated with tooth #20. The chief complaint was slight numbness radiating to the left side of the chin. Differential diagnosis: 1) Root fracture 2) Failing root canal.

Periodontal probing around tooth #20 was within normal limits. Since the probing was WNL, an apicoectomy was the choice of treatment.

 Pre-op of tooth #20 with extensive bone loss
Apicoectomy image
 Post-op with super EBA retrograde filling
Apicoectomy image
 6-month recall healing with total bone fill
Apicoectomy image

Notes: Special care was used in this case to ensure that the mental nerve was not disrupted. The lesion was so large that the mental foramen was not radiographically visible. A biopsy was performed because the lesion was larger than usual. In summary, the biopsy returned with typical pathology associated with a failing root canal. In addition, bone filled in completely around the apex and the initial numbness disappeared within 2 months.