title: Orthograde retreatment and apexification after unsuccessful endodontic treatment, retreatment and apicectomy.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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 and infected mandibular right first molar. The periapical radiolucency eventually disappeared following a second orthograde retreatment. Teh 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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, Restorative Sciences and Endodontics, University of Michigan Dental School, Ann Arbor 48109-1078, USA. csedgley@umich.edu
authors.forename: C M
authors.initials: CM
authors.lastname: Sedgley
authors.forename: R
authors.initials: R
authors.lastname: Wagner
mesh_terms: D001047:Apicoectomy; D002126:Calcium Hydroxide / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008963:Molar; D010483:Periapical Diseases / Q000628:therapy; D012008:Recurrence; D019233:Retreatment; D012184:Retrograde Obturation; D012388:Root Canal Irrigants / Q000627:therapeutic use; D012390:Root Canal Therapy / Q000379:methods*; D019227:Tooth Apex / Q000187:drug effects / Q000473:pathology*
chemical_list: D012388:Root Canal Irrigants; D002126:Calcium Hydroxide