Case 12 Tooth with no visible (negotiable) canal system

Pre-op tooth #12

Tooth was symptomatic. Radiographic evidence of no canal system. In this case, surgical approach was necessary as canals could not be negotiated (I tried).

Immediate post-op tooth #12

Surgical approach with 2 retrofills.
Note: the density at the end of the root is not a root tip.

18 month check x-ray tooth #12

Tooth was asymptomatic.

Comment: When radiographic evidence shows no evidence of a negotiable canal system, you must look. Orthograde treatment almost is always better than a surgical approach without benefit of obturated canals.  However, in some cases surgery is necessary and retrofills must be placed. As the canal systems have never been cleaned, close follow-up is always necessary.  If there is any evidence of a radiographic lesion developing or patient experiencing symptoms, the surgery must be redone or the tooth extracted.  Don't forget, a detailed explanation to the patient is extremely important.