Page 36 - The Beauty and Sorrow in Endodontics-Chapter 2

bridge (the patient understands increased difficulty to maintain good oral

hygiene and risks of losing bone volume); and

3) Antibiotic along with incision and drainage only.
O I/O: Large abscess with a sinus tract on the buccal gingival between 31 and 41
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with suppuration upon palpation (Fig 26A)
# 32, 41, 42 STP (+)

# 31 STP (++), PD WNL, crown margin WNL

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Rad: Sinogram with gutta percha cone points to 31 (Fig 26B)
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31 Periapical radiolucency with one clear canal (Fig 26C)
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A Dx: 31
Pulpal: Necrosis

Periapical: Chronic apical abscess

P Discussed proposed treatment plan with the patient. Informed consent obtained
to proceed.

1) 31 Root canal retreatment through the crown
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Rubber dam isolation. Access completed without local anaesthetics

through the existing crown with no discomfort to the patient. Cleaning and
shaping completed utilizing the envelope of motion. Master cone fit verified
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and disinfected (Fig 26D). Final irrigation with NaOCl and canals dried with
paper points. Warm vertical compaction obturation (Fig 26E, 26F). Fiberpost

with resin core (Fig 26G, 26H). Occlusion reduced. Final radiograph taken
(Fig 26I).

Rx: Clindamycin 300mg TID for 7 days

2) Follow-up

2-weeks – Care call; The patient reported the buccal gingival abscess has

healed and he has no discomfort or concerns eating.
30-months – The patient returned to the clinic due to concerns regarding

tooth 46. He was happy with the treatment result of 31 and had
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#
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not returned since “everything felt great”. Radiographic
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