THE CASE FILES CASE 006 — MANDIBULAR MOLAR

Out, repaired, and home again.

A failing root canal locked behind a large metal post — unreachable from above, impractical from the side. So the tooth came out, was repaired in fifteen minutes, and went back in.

INTERESTING ✦✦✦ EXTREME UNDER 15 MIN EXTRAORAL
CBCT at 12-month recall showing bone regeneration and healing
Pre-operative radiograph showing apical lesion and failed root canal with post
BEFORE AFTER
◂▸
Out, repaired, and home again
CASE 006 — INTERESTING · TORRANCE
THE PLATES — FULL SEQUENCE
Pre-op radiograph — apical lesion and failed root canal with post CBCT 3D reconstruction of the periapical lesion Radiograph of the extraction socket Extraoral apical sectioning of the extracted tooth MTA retrofill placed on the extracted tooth Radiograph immediately after reimplantation
THE CASE

One tooth's journey, in four beats.

01
THE PROBLEM

Every door blocked.

A 54-year-old Palos Verdes patient with sudden severe pain in a lower molar: the old root canal failing, and a large metallic post making conventional retreatment impossible.

02
THE PICTURE

A third way.

With retreatment blocked and apicoectomy impractical, one option preserved the natural tooth: deliberate extraction, repair outside the mouth, and immediate return — planned to the minute on CBCT.

03
THE WORK

Fifteen minutes, out of body.

Atraumatic extraction protecting the ligament; 3mm of infected root tip resected; an ultrasonic retrograde cavity prepared and sealed with bioceramic MTA — all under magnification, all against the clock.

04
THE RETURN

Back in its socket.

The tooth reseated with the ligament still alive. At twelve months: pain gone, lesion healed on CBCT, bone regenerating, no resorption — a natural tooth where an implant would have been.

THE PROTOCOL
  • ✦  CBCT planning — root morphology, lesion extent, extraction approach
  • ✦  Everything staged in advance: the tooth must be back in its socket within 15 minutes
  • ✦  Atraumatic extraction preserving the periodontal ligament
  • ✦  3mm apical resection + ultrasonic retrograde preparation, extraorally under magnification
  • ✦  Bioceramic (MTA) retrofill sealing the apical anatomy
  • ✦  Immediate reimplantation, occlusion verified; recalls at 3, 6, and 12 months
WHAT THIS CASE TEACHES

What this case teaches.

EVIDENCE No longer a last resort Modern studies report 88–95% success with proper case selection — most endodontists now consider reimplantation a legitimate planning option, not desperation.
TIME The fifteen-minute rule Survival drops sharply once the tooth is out of its socket beyond 15 minutes. Every instrument is staged before the extraction begins.
SELECTION The case chooses the technique Blocked access from a large post is the ideal indication; curved or fractured roots are the wrong ones. Judgment is most of the outcome.
CLINICAL DISCLAIMER: PRESENTED FOR EDUCATIONAL PURPOSES WITH PATIENT CONSENT. IDENTIFYING INFORMATION REMOVED PER HIPAA. INDIVIDUAL RESULTS VARY. ALL IMAGES REPRESENT ACTUAL PATIENT TREATMENT.
THE GALLERY CONTINUES

More from the collection.

The procedure behind this case: Endodontic Surgery & Microsurgery →
MORE FROM RETREATMENT & REPAIR
  • Sealing the wrong turn — A drill searching for a canal went 2mm past where it should have — straight into the furcation. Three hours later the hole was sealed, and three years later the tooth is still here.
  • Six problems, one tooth — A failing root canal hiding a separated file, a calcified canal, a missed canal, internal resorption, and a crack — quiet and healed 3.4 years after retreatment.
  • Scheduled for extraction, still here — Another provider said the tooth had to go — a perforation, a draining sinus tract, a root canal that had failed. Five years after combined retreatment and surgical repair, it's still doing its job.
SEE ALL RETREATMENT & REPAIR CASES →
← PREVIOUS · CASE 005 — TOOTH #14 Two diseases, one tooth A 9mm pocket, swelling, and infection reaching toward the sinus — gum disease and nerve death presenting at once. The save depended entirely on treating them in the right order. NEXT · CASE 007 — MAXILLARY CENTRAL INCISOR → The front tooth that stayed At 62, with a fractured front tooth and a failed root canal beneath it, extraction and an implant seemed inevitable. The patient asked for one more opinion first.
VIEW ALL 15 CASES

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