Page 60 - The Beauty and Sorrow in Endodontics-Chapter 2

Possible fractured root

2
Possible dens evaginatus as etiology for initial root canal treatment
P Discussed proposed treatment plan with the patient. Informed consent obtained
to proceed.

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The patient was informed of the possibility of needing to extract tooth 45 if it
is cracked or has fractured root. Replacement options include implant and fixed

dental prosthesis (bridge), both requiring healthy and stable periodontium for

long-term success.
The patient was aware of possibly needing apical surgery if healing is

inadequate following root canal treatment.

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1) 45 Root canal treatment and assess for presence of cracks/root fracture

Appt 1: Rubber dam isolation. Microscopic examination revealed an

occlusal amalgam with marginal leakage and tooth discolouration (Fig 30C)
as well as crack lines along the mesial, distal and bucco-occlusal surfaces

(Fig 30D). The amalgam restoration was removed, and access completed

without local anaesthetics with no discomfort to the patient. Microscopic
examination from various angles show that the cracks were shallow and did

not extend into the chamber (Fig 30E). Old GP was found to loosely fill the
L canal, with the B canal untreated (Fig 30F). The material was removed

using 2.5% NaOCl in combination with ultrasonic tips. As soon as patency
was obtained in the B canal using a small file, pus was seen draining through

the canal (Fig 30G). Cleaning and shaping of the B canal completed with

gradual dilution of NaOCl approaching the apex. A mid-treatment
radiograph was taken (Fig 30H) and showed a section of the old GP cone

extruding out of the apex. This was removed by using an ultrasonic file with
non-cutting tip (ProUltra #8) hooked onto the cone pulled back. Canals were

irrigated followed by placement of cotton pellets and a temporary
restoration. A radiograph was taken to confirm complete removal of the old

GP (Fig 30I).

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