Again surgical non surgical dilemma
Two previous apicos were done 20 and 8 years ago. Sinus tract appeared 4 months before. Referred dentist has decided to go for non surgical retreatment but 4 visits later sinus tract was still there. On my first visit osteoplastic material granules were seen going out of sinus tract (8 years after placement!)
Preoperartive images. Apex closed with MTA (apical distal X-ray aspect) but more contrast old filling material existed on X-ray ‘s mesial aspect. What would your treatment plan? Option one: to continue non surgically, to try to remove old filling material (and to negotiate probablye through true canal) remove MTA plug ( located probably in buccal perf) then fill the space with calcium hydroxide and wait sinus tract disappeared. Option two: to trydesinfect coronal and middle thirds as clean as it could be then go for surgical way and solve apical problems.
Non surgical way was chosen to continue in this situation. The main reason was that NSTx was already started and one appointment with proper cleaning could show if the problem could be solved this way. Intracanal situation was closed to one I suggested in the beginning. Palatal wall consisted an old paste and debris. MTA plug located more buccally and actually extended natural canal shape. All this could be visualised because more buccally extended coronal access. Canal was filled with Ca(OH)2 and patient was asked to come in a week for evaluation.
One week later sinus tract was closed. We decided to continue one more week without changing dressing then to seal the apex with MTA
that was done one week later. MTA setting was checked 4 days later and coronal access was sealed with composite