Drilling more of the tooth on RC retreatment to make an access cavity for Gentlewave?

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Sep 4, 2022
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I need to have my top left first molar retreated because of infection at a root tip. I consulted with two well-regarded endodontists. They were pretty consistent about diagnosis and treatment plan: they both think the prior RCT was perfectly executed, the new infection may be due to leakage from the crown, and they both recommend retreatment with Gentlewave.

I realized after the fact that they diverged slightly on one issue, relating to the access cavity. The tooth in question had a very large MO filling, and to conserve tooth structure, the endodontist who did the first RCT (not one of the two I now consulted) made the access cavity at a slight diagonal angle through the existing filling rather than drilling down straight from the top. Everyone who's seen the x-rays has praised how conservative it was.

One of the two endodontists I consulted about retreatment said he'd be able to simply go through this same access cavity without removing any more tooth structure. But the other one said that to use Gentlewave, she'd need to extend the access cavity to the center of the tooth to have more of a straight line because she said the Gentlewave instructions say not to leave "overhangs."

I was wondering which one is right? My preference is always for more conservative dentistry but obviously don't want the procedure to fail due to lack of proper access!
 

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