Page 53 - The Beauty and Sorrow in Endodontics-Chapter 2

Rad (Fig 29B): 11 Periapical radiolucency spreading to mid-root + incomplete
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lamina dura

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A Dx: 11
Pulpal: Necrosis

Periapical: Chronic apical abscess
P Discussed proposed treatment plan with the patient. Informed consent obtained

to proceed.

The patient was aware of possibly needing apical surgery if healing is
inadequate following root canal treatment.

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1) 11 Root canal treatment and assess for presence of cracks
Rubber dam isolation. 11 ML+DL resin restoration, incisal attrition and
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palatal craze lines present under microscopic examination (Fig 29C). Access
completed without local anaesthetics with no discomfort to the patient which

further confirmed the pulpal diagnosis. Cleaning and shaping completed and
the canal irrigated with NaOCl with ProUltra tip #7 (ultrasonic). Master cone

fit (Fig 29D). Final irrigation with QMix for 1 min and canal dried with

paper points. Warm vertical compaction obturation (Fig 29E). Fiberpost with
resin core (Fig 29F, 29G).

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** Immediately post treatment, 11 can appear whiter compared to the
adjacent teeth due to the use of NaOCl (Fig 29H). Final radiograph (Fig 29I).

Rx: Clindamycin 300mg TID for 7 days

2) Follow-up

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6-weeks – Shades are now comparable between 11 and 21; a red dot was
present on the buccal gingival in place of the raised sinus tract (Fig
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29J). 11 was still sensitive to percussion and palpation.
Radiographic examination showed healing of the apical lesion (Fig

29K). The patient reported he had not been taking the antibiotics

prescribed since he did not have any post-op concerns. The patient
was made aware that the fistula opening was still present at the

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