Page 31 - The Beauty and Sorrow in Endodontics-Chapter 3

37 exhibited a radix entomolaris
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Cavity Test without anaesthetics: 37 (-)
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A Dx: 37
Pulpal: Necrosis

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

to proceed.

Note: It was discussed with the patient that 37 root canal will be completed
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followed by root amputation of the DL root (marked with a broken file) during

periodontal surgery (Fig 37B).
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1) 37 Root canal treatment
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Proper root canal cleaning, shaping, and obturation of tooth 37 was
completed (Fig 37C), including sealing the orifice to the distolingual canal
(Fig 37D). It was recommended to the periodontist to perform open flap

surgery at least 6 weeks after root canal treatment (once initial healing is
observed around the roots).

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2) Open flap debridement with amputation of 37 DL root
3) Follow-up:
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1-year – Healing of the apical lesion around 37 observed (Fig 37E). The
patient was happy with the function of the new bridge. However,
gingival inflammation and bleeding were still observed around

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both 37 and 38. It was therefore recommended that the bridge be
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replaced with individual crowns for 37, 38 along with an implant
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to replace 36. The patient rejected this treatment proposal due to
financial concerns.
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3-years – New lesions formed around teeth 37 and 38 with questionable
prognosis even with future treatments (Fig 37F). The patient
complained of bad odour and inability to chew, however, due to

financial concerns, she was not able to continue with the

recommended prosthodontic treatment, resulting in guarded
prognosis for both 37 and 38 in the future.
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