Orthograde Root canal Retreatment ? Apical Surgery with MTA Retrofilling ? or extraction and implant? Which of these options would better serve the patient?
Distal root is short, post is long so this might impair with adequate retrofilling. Adding to this statement the event of a second distal canal and we have a recipe for a potential surgery failure. At best, this second canal might make things even more difficult for the practitioner while performing a surgery.
We also have a symptomatic tooth presenting with an apical radiolucency and a small joint on mesial, thus we can assume some leakage and this would be my second justification for an orthograde revision instead of an apico. Even though apico does give a high success rate, it will not stop coronal leakage as an orthograde approach would. (assuming a good restorative replacement)
I am also quite often engaged with such teeth, and, to my opinion, removing such a post bares less failure risks than an apico in such an area.
For those who feel uncomfortable with big casted post removal or surgery, we all agree that referral is still a better option than a sad straightforward extraction and implant. Up until now this tooth with its redone root canal treatment has been functional for 4 years and is still doing just fine.