Dental Case Analysis – Apical Infection After Root Canal Treatment

Case Overview

This CBCT image shows the anterior maxillary region with multiple natural teeth. A well-defined radiolucent lesion is visible at the root apex of a previously treated tooth (circled area), indicating a persistent apical infection. Surrounding bone shows early structural changes.

Full Analysis and Diagnosis

Radiographic Findings

• Clear apical radiolucency at root tip

• Loss of normal bone trabeculation

• Root canal filling present but likely incomplete

• Lesion confined but expanding

• Adjacent teeth currently unaffected

Tooth Condition

• Root canal–treated tooth

• Possible missed canal or inadequate apical seal

• Chronic low-grade infection

• Tooth structure still salvageable

Diagnosis

• Chronic apical periodontitis

• Failed or compromised root canal treatment

• Localized periapical bone loss

Deep Clinical Examination

Infection Characteristics

• Long-standing infection rather than acute abscess

• Minimal symptoms possible despite bone damage

• Infection confined to apex but progressing

• High risk of lesion enlargement if untreated

Bone Status

• Early bone resorption visible

• Cortical plate intact

• Favorable prognosis if treated early

Time Frame to Heal

With Proper Treatment

• Infection control: 7–14 days

• Soft tissue recovery: 1–2 weeks

• Bone healing begins: 4–6 weeks

• Radiographic improvement: 3–6 months

Without Treatment

• Lesion enlargement

• Progressive bone destruction

• Pain, swelling, or abscess

• Eventual tooth loss

Process to Execute (14-Day Focus)

Days 1–3

• Clinical evaluation and CBCT review

• Confirm infection source

• Decide between retreatment or surgery

Days 4–7

• Root canal retreatment
  or

• Apicoectomy if retreatment is not possible

• Removal of infected tissue

Days 8–14

• Post-treatment follow-up

• Monitor pain and swelling

• Evaluate healing response

Issues That Will Scale Up If Untreated

• Expansion of apical lesion

• Increased bone loss

• Spread of infection to adjacent teeth

• Facial swelling or sinus involvement

• Tooth extraction requirement

Clinical Comments

Apical infections can remain silent for years and are often detected only on CBCT scans. Early intervention greatly improves tooth survival and prevents extensive bone damage.

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