Chronic Abscess #9 Root Canal Unsuccessful at 4 Weeks

In this clinical tip, Dr. Bill Nudera walks through a challenging anterior case in which a necrotic tooth (#9) with a chronic apical abscess failed to resolve after an otherwise straightforward root canal treatment. When both sinus tracts remained unchanged at the 4-week follow-up, the case shifted from routine to complex, prompting a critical reassessment of next steps.

Dr. Nudera explains his decision-making process, including when to consider retreatment, when to move to surgery, and how he evaluates risk in cases involving existing fixed partial dentures. The video follows his surgical approach step-by-step—flap design, lesion enucleation, root-end resection, ultrasonics, bioceramic retrofilling, grafting, and membrane placement—along with the real-world complications of unexpected root defects, large lesions extending to the palate, and postoperative tissue management.

He also shares candid insights about flap positioning, healing challenges, biopsy results confirming a cyst, and why certain outcomes (such as recession) occur even when the procedure itself goes well.