How an existing failing root canal can be saved through careful management.

This case demonstrates the management of chronic apical periodontitis associated with a failing root canal treatment.

The tooth was of strategic importance to the patient as it was the last standing molar in that quadrant.

Root canal pretreatment was carried out over two visits with an inter-appointment dressing of calcium hydroxide. This has been shown to reduce the bacterial load within root canals more than irrigation alone.

A good prognostic factor in root canal pretreatments is the ability to reach working length in all the canals, this is usually possible if the original anatomy has been respected during the primary treatment (i.e. no ledges or transportations).

The final result was satisfactory and the resulting prognosis was good.

The tooth was restored with a minimal preparation gold onlay. Providing a cusp coverage restoration on heavily restored root filled teeth has been shown to increase their longevity. Ensuring the extracoronal restoration is well fitting will further increase the endodontic prognosis of the tooth by preventing coronal micro leakage.

A 12 month review revealed complete healing of the apical radiolucencies associated with the tooth.