Orthograde retreatment and apexification after unsuccessful endodontic treatment, retreatment and apicectomy

Aim: To describe a case where a second orthograde retreatment was successful in the management of an infected mandibular right first molar that previously had received both orthograde and retrograde treatments. Summary: Periapical surgery is unlikely to be successful unless the root canal system has been adequately debrided and sealed. A case is described where orthograde endodontic treatment, retreatment and apicectomy were unsuccessful in the management of an infected mandibular right first molar. The periapical radiolucency eventually disappeared following a second orthograde retreatment. The second retreatment included 12 months of intracanal calcium hydroxide placement to promote apexification, thus allowing subsequent controlled obturation with gutta percha and AH26. At a 5-year review following completion of treatment, the tooth remained asymptomatic and was in normal function. Key learning points: • Orthograde retreatment is a treatment option to manage refractory lesions in teeth that have previously received endodontic treatment, retreatment and apicectomy. • Orthograde retreatment using long-term intracanal calcium hydroxide can help promote root-end closure of a resected apex.