Long Term Intracanal Medicament

Newsletter March ’08 – The attached case illustrates how useful an long term application is of an intra canal medicament in treating persistent post treatment apical periodontitis in an endodontically well treated tooth. Patient received endodontic treatment by a very competent dentist 5 years ago in tooth 10. However, the tooth developed apical periodontitis subsequently.

Patient was referred to my office for apical surgery. My approach in these cases is to retreat the tooth whenever possible. In this case, the bridge was temporarily cemented, so gaining orthograde access to root canal system was not an issue.

I retreated the tooth with calcium hydroxide as intracanal medicament for 5 months. As you can see from the 1,2 and 4 month recall, there seemed to be bony healing and i felt confident of obturating at the fifth month. MTA (mineral trioxide aggregate) was used as an apical plug and Gp+sealer for the rest of the root. Tooth was restored and bridge was permanently cemented.

Long term CaoH in this case was my choice because:

  1. Very well done initial treatment (atleast radiographically) which suggests the recalcitrant nature of bacteria in the root canal system.
  2. To get a sense of the outcome before final restorative treatment.
  3. Avoid periapical surgery.

Excellent healing is observed with this approach. patient is ecstatic that surgery could be avoided.