Second apicoectomy will save my tooth? (Photo)

In my experience, I have not seen very many second apicoectomies that have lasted very long.  I have removed many teeth with failed apicos.  With the high predictability of dental implants, I would personally have the tooth removed, a bone graft to fill the large defect from the failed apico, and a future dental implant. 

Hello.  Thank you for your question.  As dentists we oftentimes try really hard to save teeth.  Experience teaches us that there are times when it's better to remove the tooth. After reviewing your CT scan images, it looks like the bony defect is just too much.  The most important determinant for success is how completely the underlying infection can be removed. The best way to do that in this case is to remove the tooth.  With good ridge preservation at the time of removal you will have the option to restore with  either a bridge or an implant. Don't decide right now. If the bone height after healing is optimal then definitely go with the implant. If the resulting bone height is too high then consider a second graft or just go straight to a bridge. It is going to take a bit longer to complete treatment but the long term prognosis is going to be way better.  Hope this helps. Best of luck.