Treatment Options for A Premolar

A 53-year-old man has severe toothache on the right side.  Clinical exam shows + percussion at #29 without deep pockets.  Panoramic X-ray demonstrates periapical radiolucency (Fig.1 ^ (red dashed line: Mental Loop and the superior border of the Inferior Alveolar Canal)).  It appears that the tooth has recurrent apical periodontitis.  RCT retreat is apparently indicated.  But the removal of the post will make the tooth weak.  Apicoectomy with bone graft/PRF seems to be a better option.  Extraction and implant may provide with long term better prognosis.

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Xin Wei, DDS, PhD, MS 1st edition 11/06/2016, last revision 11/06/2016