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8 year recall-surgery failure? - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are -
From: Terry Pannkuk
Sent: Saturday, March 06, 2010 1:28 PM
Subject: [roots] 8 year recall-surgery failure?

We had an backup disaster in 2002 when an IT guy (who I immediately fired) 
lost all my digital radiographs/photos from 9-6-2001 to 10-25-2002, and 
screwed up the backups.   It was disaster at the time and 8 years later 
I still get occasional cases from that period on recall that give me fits.
This is one of those lost cases.  I retreated the tooth on 2/28/02 with 
combined nonsurgical/surgical endo filling the MB root with MTA in 
preparation for the surgery.  Iíve been watching the PARL and
recalled the tooth in 2004 and today, wondering if it is simply 
incomplete osseous regeneration due to a lack of scaffolding with 
periosteum or true recurrent disease.  I took a CBCT today.  The patient
has no symptoms or signs of disease and the perio is normal.  Asked her 
if she had sinus problems she said yes but all her life.  When I asked 
her if she had unilateral sinus problems related to this side,
she said, No and currently does not have sinus problems.  Her dentist 
sent her to me because of the PARL he saw on the radiograph.  I did not 
place the core.

There was a history of root fracture-apical, probably spreader loading.

Here are the CBCTís captures for opinions are attached with the PARL 
axial sections taken at three intervals.

1. Just apical to the resected root  
2. The middle of the PARL 3. At the apical 1/3 of the PARL.

Any questions, comments, treatment plan?  - Terry

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