This patient reported a history of endodontic treatment in the Far East, then retreatment a few years ago. He ended up in my office because of a persistent parulis buccal to the tooth. I decided to retreat again, but had no real success in resolving the infection. It’s a rare two-rooted lower premolar.

We decided to do some exploratory/apical surgery. After mucosal reflection, I was able to confirm a vertical root fracture that started apically. This is probably partially because weakening of the roots from the amount of intracanal instrumentation this tooth has gone through over the years.

I was not able to apically resect the root to eliminate the fracture because of the complete loss of buccal bone and the short root that would have remained. The prognosis for this tooth is hopeless.