Having had the great displeasure of extracting 3 teeth just like this in the last 2 weeks, I’d suspect cracked root also. Boy, you just feel for patients like this when it’s obvious they want to keep the tooth so badly.

I’d love to see this case followed up and posted over the next year. Will the drainage come back? Will he stay healed? Thank goodness, at least he’s assymptomatic. Thanks for sharing the case. Nice photos, by the way!

Kelly

I saw an identical case, & # 18, today except there was no apico. I stuck a cone of GPercha down the fistula & it terminated at the M root apex, clearly at one of the M canals & NOT the other mesial canal ( I need another PA to use the SLOB rule to ID which mes root canal.

Since Bob & Del got my imagination running:
– if the root is not cracked
– if the canal is reasonably filled ( obviously the final 1-3 mm is not )
– if the periolase tip can be traced to the apex through the fistula
– if the coronal restoration/crown is satisfactory/ not leaking

then why not zap it? Start at the apex  & continue to lase as you exit the fistula.
At what setting?
Followed by the hemostasis setting?

I ask because I just can’t imagine there would be enough bacteria left in the  canal in the final 1-3mm. OTOH, you say there was bacteria in the apical few mm before today to result in today’s fistula. But this case had a pre-RCT radiolucecy, but it was not draining.

I will ULTIMATELY ( not now) retreat the RCT to clean that final 1-3mm at the apex, but when I am done, that fistula (if present) is getting lased as far as it will go. It is no where near the IA nerve & I will measure the fiber  to be sure.
But before I do what I stated above as the ULTIMATE/final treatment, I am going to lase only the fistula. I will report my findings. Anybody done this already? I see no harm in attempting to heal the periradicular area prior to RCS intrumentation, & who knows, maybe it’ll heal w/out re-instumenting the canals thus saving the pt that time & effort & expense. Kind of like guys doing the apico only & not re treating the canals.
Comments welcomed.

Hi Guys, I’ll add my case here.

Pt referred to endodontist who said probable vertical fracture. Rec. Ext.
[img]https://www.laserdentistryforum.com/attachments/upload/bepretx.JPG[/img]

Xray w/ GP in place.

Gave pt. option to try ndyag.

20hz. 160mj 150 us 142 J
Fiber taken to approximately 4 mm of apex and laser fired while withdrawing fiber.

20Hz. 180mj 550us 50J
for clot.

Post op
[img]https://www.laserdentistryforum.com/attachments/upload/beposttx.JPG[/img]

6 months
[img]https://www.laserdentistryforum.com/attachments/upload/be6mthpostop.JPG[/img]

Xray to follow at next recall.

Very Grateful patient and grateful dentist.
Thanks for posting these cases and giving me the opportunity to offer an alternative to ext.

did one of these today on one that did not respond to retreatment…fill looked great….I had on my schedule to do an apicoectomy…patient was very pleased to not have to have “surgery” we will see

Lee,
I have both lasers. The treatment Case Studies I posted are all done w/ the PerioLase pulsed Nd:YAG.
I agree the Erbium would not be the laser to perform this procedure. Fear of damage to the root surface and bone, no penetration into the tissues to kill bacteria.
Jeff

Hope that works for as long as possible. If it recurs, cracked root. Seen a bunch of them over the years….