Rushing to label a tooth hopeless and proceeding to extract it can be a very costly affair for patients. Teeth with large apical pathosis should have the apical pathology managed and preferably bone regenerated prior to proceeding on to bridgework or implant based replacement. Teeth can have a regenerative potential from the PDL stem cells but also from the ability to retain soft tissue flap in a more coronal position than if the tooth was not present.
The case clearly demonstrates this. The lower incisors are buccally placed with poor endodontic obturations and poorly fitting crowns. Moreover, a large sinus resulting in dehiscence over the root of the LR1 was noted.
The options for management included:
The final result at 6 months was very favourable with complete healing of the dehiscence and resolution of the apical pathosis with bone regeneration. A further radiograph will be taken in 1 year to assess apical status of the incisors. Replacement with implants and further regeneration may be necessary if a relapse is noted.