Page 46 - The Beauty and Sorrow in Endodontics-Chapter 2

Fig 28H
1.5-years post-op
Complete reformation of the lamina dura
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#
around 45 and 46 with more resorption of
the extruded sealer.

S Age/Gender: 50M 1

CC: “Swelling on my gum”

HCC: Patient reported gingival swelling at the lower right posterior that started
a month ago. He had been taking antibiotics for a week but still

experiences discomfort when chewing.
O I/O: 45 Gingiva inflamed and erythematous, no sinus tract visible
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# 45 STP (+), APT (+), PD WNL, crown WNL, no cracks visible
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Rad: 45 Periapical radiolucency (Fig 28A)
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A Dx: 45
Pulpal: Previously treated
Periapical: Chronic apical abscess

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

to proceed.

1) 45 root canal retreatment through existing crown
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#
Rubber dam isolation. Occlusal access through 45 crown. Removal of
old GP. Ultrasonic irrigation with NaOCl (5.25%) with crown down filing
technique to debride the coronal two-thirds. Once the irrigating solution

becomes clear with no debris, NaOCl (2.5%) was then used for the initial

2
preparation of the apical third. Once a #10 file reaches the tentative working
length (tWL), the NaOCl solution is further diluted to <1% to avoid any

damage to vital tissues close to the apex (ie. mental nerve). The envelope of
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