To Save or to extract? Endodontic retreatment of a compromised maxillary premolar.

The patient was referred to the office for an endodontic evaluation of tooth 1.4. Following a previous examination by another clinician, extraction of the premolar — considered to have a questionable prognosis — followed by implant placement was proposed. Following the clinical examination and 3D imaging investigations, a diagnosis of previously treated tooth with asymptomatic apical periodontitis was established. The tooth presented with an infiltrated occluso-distal restoration. After removing it, an extensive carious lesion was identified, which had compromised a large amount of hard dental tissue, thus jeopardizing the structural integrity of the premolar. Caries removal resulted in a perforation of the pulp chamber floor, which was sealed using MTA. The root canal system was shaped, disinfected, and obturated using…