Extra-radicular infection ? (by Ilya Mer)

Patient suffered from swelling and vestibular sinus tract, buccal-lingual mobility. Probable trauma in childhood and/or internal inflammatory resorption. Previous endo was done 3 years ago. After the first visit everything was going right: tooth became asyptomatic, sinus tract tended to heal. I have tried to seal the apex with MTA but it didn’t set twice. After the first attempt of MTA placement a small fistula appeared. I’ve changed calcium hydroxide for several times but the situation stayed without clear effect.
On the 6th visit we decided to rise the flap and to do the apico
Retrofill was done with IRM, sutures were removed 6 days later

Preoperative image, sinus tract
Preoperative X-ray
gutta-percha removed from the RC
Temporary dressing with calcium hydroxide
attempt to seal the apex with MTA plug Checking the plug next appointment I found it didn't set
first look after the flap rising
all granulation tissue was removed
retrofill with IRM
6 days
Preoperative and postoperative X-rays
3 month recall
6 month recall


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