Page 25 - The Beauty and Sorrow in Endodontics-Chapter 1

(Fig 18F)

4-years post-retreatment – The patient
reported no recurrence of the swelling and was
appreciative of the efforts made to retain the
tooth. Radiographic examination revealed
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continuous lamina dura around 25 with no
apical radiolucency or signs of infection.

A 30-year-old female was referred to the clinic for consultation regarding a
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possible overextension of tooth 25 obturation (Fig 18A). According to the patient,
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ever since the completion of 25 root canal treatment, post, core, and crown, she has
noticed gum boils every so often and it is uncomfortable to chew. She reported that her

dentist had suspected periodontal disease to be the reason for her gum boils, and thus,
has completed multiple rounds of deep scaling. However, that did not eliminate her
discomfort and she went to see the referring dentist, who told her it may be due to the
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overextension of 25 and recommended complete disassembly of the crown followed
by root canal retreatment. The patient came to our clinic for a second opinion as her
crown was just recently cemented. After thorough explanation of the risks and benefits,
the patient agreed to proceed with disassembly and retreatment. Once the crown was
removed, a large amalgam core was discovered. In these cases, the entire amalgam

core will need to be removed for the following reasons: 1) prevention of any coronal
leakage during treatment, and 2) to assess the remaining tooth structure. Once the core
was removed, voids between the gutta percha and dentin wall were observed, and once

the loose gutta percha was removed, blood and pus gushed out of the canal. Proper
cleaning, shaping, and a tight coronal seal were completed (Fig 18B). Overfilled sealer
puffs can be seen on the post-obturation radiograph after a proper root canal treatment
(Fig 18C). The lateral canal around mid-root can also be visualized and is even larger
in diameter compared to the main canal. A white-in-white dotwas also seen at the exit

of the main canal, which signifies a properly overfilled canal system with apical seal.
At the six-weeks follow-up appointment, the patient reported no recurrence of gum
boil and no discomfort during function. On the six-months and one-year follow-up
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radiographs, the radiolucency around 25 apical and mid-root has healed, and its
lamina dura reformed (Fig 18D). This exemplifies that the overfilled puffs created by a
biocompatible root canal sealer does not impede the healing process of peri-radicular
lesions (Fig 18E/a, 18E/b, 18E/c, 18E/d, 18E/e, 18E/f).

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