Endodontic Retreatment & MTA Preserve the Tooth

Here's a tooth that had endodontic treatment over 10 years ago. While the clinician had difficulty finding all the canals, the tooth has been functional for quite some time. A large furcal defect raises suspicion of a root fracture or perforation.

DX: Prior RCT w/ Symptomatic Apical Periodontitis.

There are many who would consider this hopeless and recommend extraction.

Let us consider the cause of this treatment failure:

1. Missed Canals

2. Furcal Perforation or Root Fracture?

Can these issues be addressed to preserve the natural tooth?

In my consultation with the patient, I explain these issues and that endodontic re-treatment may be able to save the tooth (as long as the root is not fractured). I also explain the alternative option of extraction.

Finding missing canals is a simple solution.

A perforated root can be repaired with guarded prognosis.

A fractured root will require extraction.

I tell the patient the only way to know for sure is to open the tooth and investigate. Considering the nice crown on the tooth, the cost of attempting to save the tooth is minimal, compared to the cost of removing and replacing. In this case the patient elected re-treatment.

Pre-operative radiograph.

Upon access, 2 additional canals are located and instrumented. A furcal perforation is also identified. No root fractures are found.

Re-treatment is complete. Canals obturated with gutta percha and furcal perforation repaired with MTA. Glass ionomer base is placed over MTA.

7 month recall shows a tooth that is fully functional with remarkable healing of the furcal defect. Endodontic re-treatment has preserved the natural tooth.

Dens in Dente

Dens in Dente literally means "a tooth within a tooth". It is a developmental anomaly caused by an epithelial invagination during the development of the tooth. Enamel is laid down on the internal surface of the tooth. This is most frequently seen in maxillary lateral incisors.

A thin layer of enamel can be seen internally. An amalgam restoration was previously placed at some point to try and seal off the development groove into the dens in dente.

Access for endodontic treatment reveals the internal layer of enamel.

Endodontic treatment is completed.


This peg lateral incisor also shows the internal and external layers of enamel of a dens in dente. The large dens in dente has also affected the overall development of the tooth.
Submitted by: Dr. Rico D. Short of Smyrna, GA.