This case was done in single visit. The patient was the brother of an Endodontist and flew in from Hyderabad for treatment. I did the orthograde endo followed by immediate apical surgery. In the orthograde part, I filled the Dens tract and the canal. I then raised a flap, resected the apical part to expose the “pouch” of the dens. I used a pear shaped ultrasonic tip to clean the pouch and packed it with MTA. The patient flew back the same day and got the sutures removed in Hyderabad. A colleague, (Dr. Pavan Nallapati) send me a recall radiograph. At the 3 year recall, it seems to have healed and doing well. In hindsight, I felt i hurried through the orthograde part. when treating these cases, we inevitably leave behind a lot of anatomy untouched. I’m also thinking whether i can do these cases just surgically and leave the orthograde part as it is. I might do that the next time.