(TC41) Retrograde Prior Orthograde Endodontic Treatment: A Case Report

Abstract: Non-surgical root canal therapy (orthograde treatment) is typically the first line of endodontic treatment for pulpal and/or periapical disease. However, endodontic microsurgery (retrograde treatment) may precede orthograde treatment based on specific clinical situations. This case report outlines a strategic approach of retrograde followed by orthograde endodontic treatment leading to successful periapical healing. In November 2022, a patient was evaluated at the University of Pittsburgh Endodontics for teeth #23, #24, #25, and #26. The diagnosis was previously initiated therapy and asymptomatic apical periodontitis for all teeth, with separated instruments identified in teeth #23 and #26. After discussing all treatment options, the patient consented to proceed. A long, separated NiTi rotary file in tooth #26, spanning from the apical to coronal portions of the canal, could not be retrieved through orthograde means. With the patient's agreement, endodontic microsurgery was performed to remove the separated file via a retrograde approach. During the surgery, teeth #23, #24, #25, and #26 underwent curettage, biopsy, retro-preparation, and filling with bio-ceramic putty. Calcium silicate was also applied at the osteotomy sites. Approximately one month after the retrograde procedure, definitive orthograde endodontic treatment commenced for all involved teeth and was completed in the subsequent months. CBCT imaging and clinical evaluations conducted ten months after the initial treatment confirmed the success, as indicated by periapical healing. In conclusion, employing retrograde treatment prior to orthograde endodontic procedures can be an effective strategy for managing complex cases.