A case study by Dr. Chafic Safi, Centre Endodontique St-Laurent
A 45 year-old female presented to our office with a chief complaint:
“I can’t chew on my lower back tooth. It hurts me a lot!”
Analysis
Clinical examination revealed that tooth #47 was painful to percussion. The tooth also had a crown. Probing and mobility were within normal limits.
Radiological examination revealed that tooth #47 had already a root canal treatment. There was also a post in the distal root.
The presence of a radiographic radiolucency was suggestive of apical periodontitis.
Diagnosis
The diagnosis was: previously treated tooth and symptomatic apical periodontitis.
Treatment
The treatment options offered to the patient were:
- Intentional replantation. Prognosis: Favorable
- Non surgical retreatment. Prognosis: Guarded
- Extraction. Prognosis: Favorable
Treatment Selection
The patient consented to an intentional replantation.
The treatment
The procedure was completed under local anesthesia. The tooth was atraumatically extracted using special forceps (222AS by Karl Schumacher).
Care was taken not to injure the PDL in order to avoid possible external resorption.
Once extracted, the tooth was continuously irrigated with Hanks’ Balanced Salt Solution (HBSS) in order to keep the PDL cells alive.
Within a time window of 10 minutes, the roots were resected, stained to identify any crack or isthmus, retro-prepared, retro-filled using Bioceramic Root Repair Material, and replanted into the socket.
Follow-up
At the 1-year follow-up visit, the patient was asymptomatic.
Probing and mobility were within normal limits.
The radiograph shows complete healing of the periapical tissues.
The patient was awaiting delivery of a new crown.
