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The root canal filling material (3, 4, and 10) does not extend to the end of the tooth roots (5, 6 and 11). The dark circles at the bottom of the tooth roots (7 and 8) indicated infection in the surrounding bone. Recommended treatment is either to redo the root canal therapy or extract the tooth and place dental implants.
The proximity of the root to the canal can be assessed radiographically and there are several factors which can indicate high risk of nerve damage: [21] Darkening of the tooth root where it crosses the canal [21] Deviation of the canal [21] Narrowing of the roots [21] Loss of the lamina dura of the canal [21]
Tooth #5, the upper right second premolar, after extraction. The two single-headed arrows point to the CEJ, which is the line separating the crown (in this case, heavily decayed) and the roots. The double headed arrow (bottom right) shows the extent of the abscess that surrounds the apex of the palatal root.
A tooth is unsuitable for periradicular surgery if it does not have a good periodontal support or coronal seal. It must have enough structure to support restoration. Filling the root canals of the tooth from the crown (orthograde root canal therapy) should be the first treatment option to resolve inflammation caused by the tooth.
A root end surgery, also known as apicoectomy (apico-+ -ectomy), apicectomy (apic-+ -ectomy), retrograde root canal treatment (c.f. orthograde root canal treatment) or root-end filling, is an endodontic surgical procedure whereby a tooth's root tip is removed and a root end cavity is prepared and filled with a biocompatible material.
Risk of occurrence of a phoenix abscess is minimised by correct identification and instrumentation of the entire root canal, ensuring no missed anatomy. Treatment involves repeating the endodontic treatment with improved debridement, or tooth extraction. Antibiotics might be indicated to control a spreading or systemic infection.
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