A male in his thirties visited the dental clinic with a persistent complaint of pain in the lower left back tooth region. The discomfort was specifically localized to tooth 36, a molar that had undergone root canal treatment in the past. Despite prior treatment, the patient reported ongoing pain and occasional swelling, especially during chewing.

Initial Assessment:

Clinical examination revealed a previously treated molar (tooth 36) that showed tenderness on percussion and slight inflammation in the surrounding gingival area. Radiographic analysis confirmed the presence of a periapical radiolucency, suggesting the development of a periapical lesion, most likely due to persistent or recurrent infection in the root canal system.

Diagnosis:

Previously root canal treated tooth (tooth 36)

Periapical pathology indicating failure of the initial treatment

Indication for nonsurgical root canal retreatment (Re-RCT)

Treatment Workflow

1. Root Canal Retreatment InitiatedThe initial step involved the removal of the existing gutta-percha (GP) filling. This was done meticulously to avoid structural damage to the root and to allow for proper disinfection of the canal system.

2. Intracanal Medicament Placement (ICM)Following GP removal, calcium hydroxide was placed as an intracanal medicament to disinfect the canals and aid in the healing of the periapical lesion. The tooth was sealed temporarily, and the patient was recalled after a week for further evaluation.

3. Canal Cleaning, Shaping, and ObturationAt the subsequent visit, the canals were thoroughly irrigated, shaped, and dried. A complete obturation was done using gutta-percha and sealer, ensuring the root system was well sealed.

4. Post-Endodontic RestorationAfter successful obturation and resolution of symptoms, the tooth was restored with a fibre-reinforced composite core. This material was selected for its superior strength, especially in posterior load-bearing areas.

5. Full Coverage CrownTo protect the structurally compromised molar and enhance its longevity, a full-coverage crown was placed. This also restored proper occlusal function and aesthetics.

Outcome and Prognosis

The patient reported complete relief from symptoms after retreatment. Radiographic follow-up is planned to monitor the healing of the periapical lesion. The combination of thorough disinfection, appropriate medicament use, and a strong post-endodontic restoration greatly improves the long-term prognosis of the tooth.

Clinical Insight

Retreatment cases like this underscore the importance of early detection of endodontic failures and comprehensive disinfection of the root canal system. The use of intracanal medicaments plays a vital role in controlling infection and promoting periapical healing. Additionally, restoring the tooth with a reinforced composite and crown helps prevent fracture and reinfection.

Conclusion

Tooth 36, which had developed a periapical lesion post-RCT, was successfully managed through retreatment, disinfection, and a durable restorative plan. The case reinforces the value of evidence-based endodontics and the role of strong coronal protection in ensuring long-term tooth survival.

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