Jon Richards DDS MS
This retreatment is a good example of the benefit of a multi-visit approach.
The initial endodontic therapy was completed less than a year ago in a single visit. Symptoms were improved, but biting tenderness remained and persisted until the time the patient was referred after seeking an opinion from another general dentist.
At the time of eval, tooth #4 was found to be mildly percussion tender. The PA radiograph and CBCT were not suggestive of any periapical pathosis.
After access and removal of the obturant, patency was established and the canal was cleaned and mediacted with CaOH for one month. The patient returned with improvement but not resolution of symptoms. Another round of instrumentation with hand files (no canal enlargement) and Ca(OH)2 was completed. The patient reported increased tenderness for about 3 days, but then complete resolution of his pain.
At the third appointment the canal was obturated and a fiber post and composite core was placed while #4 was still isolated under a rubber dam.
By delaying obturation until after symptoms had resolved, we increase our confidence that the patient will have long term success. It also prevents losing control and rushing to a surfical approach because of the problem created by a post in the canal.