Multidisciplinary Rehabilitation Involving Endodontic Retreatment and Implant Planning

Prosthodontics
Pre-treatment panoramic view showing multiple endodontically treated teeth and bone levels prior to rehabilitation.

Pre-treatment panoramic view showing multiple endodontically treated teeth and bone levels prior to rehabilitation.

Pre-treatment CBCT slice showing periapical radiolucency associated with previously treated tooth.

Pre-treatment CBCT slice showing periapical radiolucency associated with previously treated tooth.

Post-endodontic retreatment periapical radiograph showing dense obturation and initial healing of periapical lesion.

Post-endodontic retreatment periapical radiograph showing dense obturation and initial healing of periapical lesion.

Post-treatment panoramic radiograph showing final restorations and stable bone levels around implants.

Post-treatment panoramic radiograph showing final restorations and stable bone levels around implants.

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Diagnosis

  • Radiographic Findings:

    • Periapical radiolucency associated with previously treated teeth, suggesting endodontic failure.

    • Presence of old crowns and posts with possible root fractures.

    • Multiple missing posterior teeth with adequate bone height for future implant placement.

    • Residual infection at the apex of endodontically treated teeth.

  • Clinical Findings:

    • Missing Ferrule effect

    • Tenderness on percussion in upper premolar and molar regions.

    • Compromised restorations with poor marginal seal.

    • Satisfactory oral hygiene, but localized gingival inflammation around old crowns.

  • Diagnosis:
    Combined endodontic and prosthodontic failure, requiring retreatment and partial implant-supported restoration.

Treatment Objectives

  1. Eliminate periapical infection via endodontic retreatment.

  2. Restore missing teeth with implant-supported crowns.

  3. Replace failing prosthetic restorations with new fixed units.

  4. Achieve full function and esthetics while preserving natural teeth when possible.

Treatment Plan

  • Step 1: Cone-beam CT (CBCT) evaluation and periapical radiographs for root morphology and lesion extent.

  • Step 2: Removal of old restorations and posts, followed by root canal retreatment and obturation.

  • Step 3: Extraction of non-restorable teeth.

  • Step 4: Guided implant placement after healing period.

  • Step 5: Fabrication of new crowns and bridges, ensuring occlusal harmony.

  • Step 6: Final panoramic evaluation and follow-up.

Clinical Procedure Summary

  1. Endodontic Retreatment: (Done by Endodontist)
    Old gutta-percha removed, canals cleaned, shaped, and obturated.

  2. Radiographic Verification:
    Periapical images confirmed dense, uniform obturation.

  3. Implant Phase: (Done by Implantologist)
    Implants placed in posterior areas under local anesthesia; healing abutments placed after osseointegration.

  4. Prosthodontic Phase:
    New fixed restorations fabricated and cemented; occlusion verified.

Results

  • Successful elimination of periapical lesions.

  • Functional occlusion re-established with implant and tooth-supported restorations.

  • Radiographic evidence of bone healing and stable implant integration.

  • Patient reported comfort and improved masticatory efficiency.

Discussion

This case demonstrates how interdisciplinary coordination between endodontics and prosthodontics ensures long-term success.
Radiographic follow-up is critical to verify periapical healing and implant osseointegration.

Reflection / Learning

  • Use of CBCT improves detection of missed canals and periapical pathology.

  • Sequential treatment (endodontic first, implant later) reduces complications.

  • Restorative design should consider load distribution between implants and natural teeth.