Tooth #20 presented with previous RCT and persisting Symptomatic Apical Periodontitis. The periapical radiolucency is bi-lobed, suggesting two portals of exit. It is important to locate and clean complex anatomy in order to heal the disease. The location of the “lobes” of the lesion give the location of the anatomy away, as the POEs tend to be centered in each lesion. I almost always complete re-treatment cases in multiple visits, to utilize calcium hydroxide as an inter-appointment medicament. There have been a few recent studies suggesting a good efficacy of negative pressure irrigation (the Endovac) in aiding canal cleanliness, even in one visit. This was my fist case using the Endovac in a one-step re-treatment. The shape was finished at 40-08, which is bigger than I would shape it to today. After debriding the accessory canal and flowing high volumes of irritant to the apex, the two year recall shows an excellent result with complete regeneration of the periapical tissue.
Two year recall: “Strindberg” success.