This root canal was orginally done in 1982 and an instrument was separated at the time. Within the next two years, the tooth was treated with an apicoectomy to remove the separated instrument. This was "Old School" endo surgery. No microscope with an amalgam retrofill. Despite this, the tooth was retained (survived) for 25 years. You can tell that the amalgam retrofill came loose and the apical seal was jeopardized. An apical radiolucency is apparent.
We discussed with the patient the possibility of a root fracture, but that the most likely reason for the apical lesion was the lost retrofill. We recommended endodontic microsurgery to retreat the lost retrofill. The patient agreed and procedure was peformed.
A root end fracture was found. At this point, we decided to go ahead and resect the root to see how far the fracture went. (I decided that rather than remove more bone looking for the dislodged amalgam, I would leave it.)
A six month recall on the tooth reveals complete healing of the bone and full function of the tooth. No pain to percussion, normal probings. Despite a small root end fracture, this tooth was treatable with endodontic microsurgery. The endodontic microsurgery option has allow this patient to retain his natural tooth and keep his 3 unit bridge.