Results of Failed Endodontic Treatment and Apical Surgery

• Name – Dr Vasudev Tomar
• Age – 26 years
• Gender – Male

The patient noticed discoloration in the same tooth for which he underwent root canal treatment, and a PFM crown was also given in 2009. The patient had trauma in 2016, for which he visited a dentist with swelling and pain in the same tooth. His dentist planned and performed an unsuccessful apicoectomy procedure, and the patient again went for the same process after eight months.

Dr. Rajat Sachdeva MDS, MS, Implantologist at Dr. Sachdeva’s Dental Aesthetic and Implant Center, Delhi.

• Pain and swelling in the upper anterior region.
• Tenderness with upper front teeth.

Periodontitis is an inflammatory condition that affects the periodontal tissues and is caused by a variety of factors. Loss of alveolar bone support is the anatomical sequela to the advancement of periodontitis apically among all the specific indications of periodontal disease.

Periodontitis causes bone loss, which can occur in a single type or several combinations. It’s critical to understand all of the periodontal osseous abnormalities are linked to periodontal disease. Identifying these osseous flaws on surgical exposure of bone is clinically challenging, and a dental surgeon must comprehend and categorize these defects to have better therapeutic options.

Periodontal disease causes bone loss at local sites, although systemic and regional variables regulate it. The most crucial element in periodontal attachment loss, which leads to tooth loss, is bone resorption.

The patient visited our dental clinic in Ashok Vihar, Delhi, with the complaint of pain and swelling in the upper left central incisor for the past three months. The tooth was endodontically treated, and a metal-ceramic prosthesis was fabricated. There was tenderness on percussion, and the radiograph revealed a periapical lesion with external resorption of the root. CBCT scan revealed a significant cortical, subcortical osseous defect noted in apical periradicular and periapical regions. Apical blunting was also noted that is resorption of the apical third of the root.

As the tooth showed a poor prognosis with repeat endodontic treatment and apical surgery, Dr. Rajat Sachdeva, our expert dentist, decided to extract the tooth and replace it with an implant-supported prosthesis. Further, Dr. Sachdeva planned an immediate implant considering the patient’s age and desire for early restoration.

Our dentist recorded both upper and lower arch impressions before surgery for provisional restoration immediately after surgery.

Dr. Rajat Sachdeva extracted the tooth carefully to maintain the integrity of the labial plate after the administration of a local anesthetic agent. He raised the full-thickness flap, thoroughly cleaned the infected site and the infected periapical tissue with curettes and proper irrigation. The infected bone was cleansed with the help of piezo tone surgical tips.

The labial wall was intact coronally. However, a fenestration was present in the apical region of the socket on the labial aspect. All the granulation tissue and infection were cleaned and rinsed thoroughly.

Then, the site was prepared for immediate implant placement. Dr. Sachdeva placed an implant of size 4.1*12mm in the extracted area. Proper care was taken to prepare the site to maintain the implant’s palatal position to retain a gap of at least 2mm between the implant and the labial plate. Good primary stability of the implant was achieved.

Dr. Sachdeva grafted the labial wall defect using a cerabone granulate bone graft and fixed a bio-guide collagen membrane (30-40mm) over the grafted tissue. He also placed a 3-0 mersilk interrupted sutures. Lastly, a coe-pak dressing was applied to the patient.

Aftercare instructions and medications were given to the patient.

This is what the patient, Mr. Vasudev Tomar has to say about the treatment: ” I am delighted with my dental treatment. Before, I suffered from severe pain and swelling due to periodontal issues. But now, I am pain-free, thanks to Dr. Rajat Sachdeva’s efficient treatment.