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Healing of peri-radicular area after treating fourth canal

A patient presented with pain and swelling on the first upper left molar tooth. Radiographic examination confirmed the presence of peri-radicular radiolucency, possibly caused by infection (Figure 1). The prosthetic crown was removed and the root canals re-treated. During the process the previously untreated mesiopalatal ("fourth") canal was also located and treated. A new crown was placed. After thirteen months the lesion appeared to have healed (Figure 2). The fourth canal is clearly visible in the radiograph. 

Patients such as these are often advised to undergo extraction or apical surgery (apicectomy) without any attempt at re-treatment. This case shows that it is possible to salvage a tooth by re-treatment of the root canal. It is important to always locate all canals.

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