Pre-operative x-ray #19
Silver Cones tend to corrode over time. In this particular case tooth #19 was treated decades ago and was now symptomatic. There is bone loss around both roots. Retreatment is probably the only option besides extraction. Even the retreatment prognosis is guarded due to the bone loss already present.
Canals clean. A fourth canal was found in the distal root. The distal buccal and distal lingual canals joined.
Immediate post-operative x-ray #19
Case completed canals obturated with gutta percha.
13 month recall x-ray
Patient is asymptomatic. Healing is incomplete at the mesial apex. The corrosion products from the silver cones probably prevent complete healing, but follow up will continue.
Comment: Silver cones tend to corrode over time. Retreatment or extraction are ordinarily the two options. At times apical surgery is appropriate but definitely not the first choice.