Apicoectomy 18 with BoneLid

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Posted on By Markus Schindler In Endodontics

Apicoectomy on 18 and retrograde Root-Canal-Filling with MTA.

The Patient has been referred with persisting Pain after Enddontic treatment. He suffers from strong retching, so pretreatment was not an Option he would go for.

We decided to get access to the apical region with a BoneLid because the buccal cortical Wall was about 7mm thick. The retrograde Root-Canal preparation was performed with piezoinstruments. The retrograde filling with MTA.

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Can I play devil's advocate and ask why?
Would it not have been simpler and less risky to extract and consider implant ll6 and/or ll7.
Do you feel the prognosis for an apicectomy greater than implant?
Would you have CBCT prior to treatment
I often find persistent pain post excellent root filling to be a crack


Thank you for your question.

We were discussing dental implants as an alternative treatment with the patient.
Regarding his limited ability to maintain proper hygiene around the implant (strong retching, my hygienist tried to clean but it was not possible) we decided to conserve the tooth and discard the implantologic approach for the next years.
In 6 months we will reevaluate the apical reossification with a radiological examination and decide wether to go for a conventional Bridge (in deep sedation) or just leave the situation as it is.

I am convinced that we have an excellent prognosis for this tooth: New Endodontic treatment from an experienced Dentist, Microscopic endodontic surgery with MTA-Root-Canal filling.

Kim and Setzer found a Successrate of 93,1% in this meta-Analysis (which is comparable to Implant success rates).

Outcome of endodontic surgery: a meta-analysis of the literature--part 1: Comparison of traditional root-end surgery and endodontic microsurgery.
Setzer FC1, Shah SB, Kohli MR, Karabucak B, Kim S., J Endod. 2010 Nov;36(11):1757-65. doi: 10.1016/j.joen.2010.08.007. Epub 2010 Sep 17.

A CBCT was , in my opinion, not necessary because it wouldn't change the therapy. The sensitivity and specificity for diagnosing dentinal cracks in teeth with rootcanalfilling ist poor, due to artefacts (Talar et al., J.Endod, 2016 Jan;42(1):12-24)


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