Page 39 - The Beauty and Sorrow in Endodontics-Chapter 3

Etiology: Pre-op: Combined endo-perio?

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P Options for 46 given: 1) 46 endo re-treatment, 2) I&D, 3) extraction, 4) No
treatment. Risks and benefits of each discussed with the patient. He chose to
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proceed with option 1 – 46 endo re-treatment. Informed consent was given to
proceed.
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1) 46 Root Canal Retreatment
Rubber dam isolation. Access completed through the existing amalgam

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restoration without any local anaesthetics. Once the old obturation material
was removed from both M and D canals, pus gushed out of the D canal.

Even after copious irrigation with <1% NaOCl solution, there was still
drainage of pus. The tooth was left opened to allow for drainage and the

patient was informed to return in 2-3 days to complete disinfection of the
canals and coronal seal. The patient was informed to frequently rinse and

maintain good oral hygiene to allow for the drainage to continue.

Unfortunately, the clinic was unable to reach the patient and he did not
show up for his second appointment.

2) Follow-up

Unable to reach the patient via phone, the patient presented to the clinic
more than two months after the last appointment. The author had collected

the radiographs taken over the years to show the patient and his relatives the
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progression of the lesion and to discuss the prognosis of 46 retreatment as
well as the need for patient cooperation.
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The patient had first presented to the clinic for consultation of 46 a
year ago (Fig 38B), he had declined treatment at that time since the

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discomfort was tolerable. The referring dentist had recommended 46
retreatment for over 10 years and has documented the progression of the

lesion over the years (Fig 38C, 38D, 38E, 38F, 38G). However, the patient
never consented to treatment.

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Note No anaesthetics were given for the following reasons:
1) To avoid spreading the infection into deeper tissue layers with the needle

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