Smile Makeover · Abdullah N., 40s
The Tooth That Was Written Off
A failed root canal, a recommended extraction, and a fourth canal that nobody had found.
- Treatment
- Smile Makeover
- Duration
- 4 months
- Appointments
- 5 visits
- Clinician
- Dr. Omar Reda
Patient Goal
What they came in for.
He arrived with a referral letter recommending extraction and an implant on his upper right first molar. He wanted a second opinion before agreeing to lose a tooth he had already paid twice to keep.
Initial Condition
What we found.
Tooth 16 with a previous root canal treatment completed six years earlier, now presenting with a persistent buccal sinus tract and tenderness to percussion. The periapical radiograph showed three filled canals and a lesion at the mesiobuccal root. A small-field CBCT showed what the flat film could not: an untreated second mesiobuccal canal, and the lesion sitting directly over its apex. The tooth was otherwise restorable, with a sound crown margin and no fracture line.
Final Result
Where it finished.
The sinus tract closed within three weeks of the canal being located and disinfected. The periapical lesion showed complete radiographic bone fill at twelve months. The tooth is symptom-free, under full cuspal coverage, and still his.
Patient Experience
In their words.
His view afterwards was uncomplicated: he had been told the tooth was finished, and it was not. What he wanted from the appointment was someone to look properly before removing something permanent.
The plan, before anything started.
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Phase 01
Imaging
Small-field CBCT to determine whether the failure was a missed canal, a fracture, or something unrestorable. This decision could not be made on a flat radiograph.
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Phase 02
Retreatment
Removal of the existing filling material from all three treated canals and negotiation of the untreated MB2.
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Phase 03
Disinfection
Extended ultrasonically activated irrigation and a four-week course of calcium hydroxide dressing.
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Phase 04
Obturation
Warm vertical compaction of all four canals, with a bonded core placed immediately.
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Phase 05
Coverage
The existing crown replaced with a new lithium disilicate onlay restoring full cuspal coverage.
Treatment process
What actually happened, in order.
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Visit 1
CBCT and diagnosis. The MB2 canal was visible on the axial slice, and the lesion was directly over its apex — which made the cause of failure unambiguous.
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Visit 2
Crown removed, old filling material retrieved from three canals, and the MB2 located under the microscope at 16x. It had been sealed under a shelf of secondary dentine.
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Visit 3
All four canals shaped to length, irrigated with ultrasonically activated hypochlorite, and dressed with calcium hydroxide for four weeks.
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Visit 4
Sinus tract resolved and percussion tenderness gone. All four canals obturated by warm vertical compaction; bonded core placed the same visit.
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Visit 5
Scanned, milled and fitted a lithium disilicate onlay with full cuspal coverage. Twelve-month review radiograph showed complete bone fill at the mesiobuccal apex.
The same mouth.
Photographed under identical lighting, 4 months apart
- 4th canal
- Located under microscope
- 12 mths
- To complete bone fill
- 1
- Extraction avoided
Technology used
What it took.
- Small-field CBCT
- Surgical operating microscope at 25x
- Ultrasonic irrigant activation
- Warm vertical obturation
- CEREC same-day onlay
Every item here is in the building. See how it is used.
Start your own
Every case here began with one hour.
An examination, your own images on screen, and a written plan with a price. Whether you proceed is a separate decision, made later.
Or call +965 2242 8800 — Sunday to Thursday, 9:00 to 20:00.