This tooth had been retreated once, and was failing to heal. Over time, an increase in the radiolucent lesion around the MB root was detected. The patient was then presented the options:
1. Root canal surgery to treat the MB root
2. Extraction & tooth replacement
Since the crown was in good shape, the patient wanted to try and save the tooth. The patient was informed that we would surgically expose the tooth, evaluated the root end. If no fractures are found, then we would recontour the root end (apical resection) and then place a reverse filling (retrofilling) in the end of the root. Patient was also informed if a crack is found down the length of the root, we'll have to review other options.
After flap reflection and curretage and apical root resection. You can see that there is only a small bridge of bone across the buccal of the MB root.
A crack is seen on the palatal side of the MB root. The patient at this point is informed of the fractured root. He is given the option to stop and extract the tooth, or proceed with a root amputation.
Here you can see the MB root has been removed. The gutta percha is exposed. A retropreparation and retrofilling must still be completed to prevent coronal leakage into the canals system.
A root amputation is a great way to buy some time for this tooth. It allows the patient to retain the natural tooth, but I make sure the patient knows that if another root becomes fractured, they will have to remove this tooth.
Following the retropreparation. I have sometimes seen root amputations performed without doing a retropreparation and retrofill. That would be the same as doing a root canal without placing a permanent restoration. Bacteria will leak in and contaminate the root canal.
Retrofilling placed. In this case, it was a glass ionomer.
Final Film. After root amputation is completed. It is important to reduce the occlusion to make sure that all occlusal forces are directed over the remaining roots. While a root amputation is not the best call for all patients, we should be aware of this treatment option and the service that it can provide to our patients.