This is one of those pesky problem case types- the “dreaded disto-palatal” rooted tooth. There is furcal bone loss present, and further, the bone loss proceeds around all the roots and heads distal quite a bit. After six months in calcium hydroxide I thought things were improving and root-filled the tooth. At two years, not much healing could be observed and the swelling returned. We decided surgery was the best option to retain the tooth (here is how we explain root canal surgery to patients). Some of these I’ve been doing with resection, retro-preparation, and retro-fillings like this one. Some I’ve just removed the soft tissue. Both approaches seem to be working when I was the one performing the original endodontics.