Question

RCT of maxillary second premolar without apical pathosis was obturated w/ gutta percha to within 1 mm of radio graphic apex; 12 months later there is a periapical radiolucency of 5 mm in diameter; tooth is asymptomatic, dental amalgam restoration is present:

If a post, core and crown had been placed on the tooth, which of the following procedures should be performed?

A. Apical curettage only
B. Apical curettage and apicoectomy only
C. Apical curettage, apicoectomy and retrofill
D. Conventional root canal retreatment
E. None of the above. Further treatment is unnecessary.

Answer 1

For a maxillary second premolar with a periapical radiolucency 12 months after obturation, conventional root canal retreatment is typically the recommended procedure to address the issue, despite the asymptomatic status and existence of post, core, and crown.

Step-by-step explanation:

If a maxillary second premolar without apical pathosis was obturated with gutta percha to within 1 mm of the radiographic apex and 12 months later there is a periapical radiolucency of 5 mm in diameter despite the tooth being asymptomatic, and a dental amalgam restoration is present, further treatment will be necessary in most cases. Even if a post, core, and crown had been placed, the presence of a radiolucency indicates a failed root canal or a possible secondary infection. The appropriate action to take would be conventional root canal retreatment (D), which involves removing the existing gutta percha, cleaning the root canal system again, and re-obturating the canal. This is the first line of treatment recommended to resolve the periapical radiolucency before considering more invasive procedures like apical curettage, apicoectomy, and retrofilling (C), which may become necessary if retreatment fails or is not feasible due to anatomic considerations.