Re-treatment of tooth #18 with 5 canals

A 50 year-old male presented with a large asymptomatic radiolucency associated with tooth #18. Tooth #18 had root canal therapy completed 2 years ago by his general dentist. The root canal appeared to be completed very well. Bone loss was apparent at the apex of both roots progressing up the mesial root. Periodontal probing was within normal limits. In addition, there was a long post in the distal canal.

Differential diagnosis: 1) Vertical root fracture 2) Failing root canal

Treatment options:

 1) Re-treatment
 2) Apicoectomy
 3) Extraction
 Pre-Op Tooth #18
Apicoectomy image
 Post-Op Tooth #18
Re-treatment Canals
 6 Month Recall Tooth #18
Re-treatment Canals

Treatment Notes: The post-operative X-ray shows 4 canals in the mesial roots. 2 untreated canals were found in the mesial roots. Treatment consisted of post removal from the distal root and re-treatment of all canals. Since untreated canals were found and treated, the prognosis is good to excellent. X-ray #3—6month recall shows bone starting to fill in. The prognosis is now excellent since bone is regenerating.