London Endodontics
Dr. Victor Wagner & Dr. Anu Bhalla
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Healing - Case 1

This was a case that already had a failing RCT and a large apical lesion. This film is immediately after a retreatment had been done. Unfortunately a considerable amount of gutta-percha and Kerr sealer extended beyond the apex. This is not intended, but rarely happens with large apices. MTA was not available at this time.
This is 10 years later. Very good apical osseous healing and it remains asymptomatic. This supports the theory that gutta-percha and Kerr sealer, although they may act as physical irritants if extruded, are chemically inert and will have no other deleterious effect as long as the canal is well sealed. There is no need to move immediately to apical surgery in the absence of symptoms or lesions.
Normally we can control the apical extent of our obturation quite nicely. This is the main concern when dealing with large canals. Here, we see multiple lateral canals causing lateral leakage, a lateral lesion, as well as a large apex with it's own lesion.