Page 40 - The Beauty and Sorrow in Endodontics-Chapter 3

tip; and

2) Local anaesthetics are unlikely to be of any use due to the extreme acidic

environment created by the infection.

S2 The patient presented to the clinic 2 months after the initial appointment
MH: No changes

CC: “Want to continue with the re-treatment”

The patient reported he had been busy through lunar new year and did not want
to bother his children to take him to the dental office.

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O2 I/O: 46 STP (+), APT (+), M1, PD 5-6mm with bleeding
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A2 Dx: 46
Pulpal: Previously initiated

Periapical: Symptomatic apical periodontitis
Etiology: Pre-op: Combined endo-perio?

Post-op: Endo only
P2 Discussion with the patient and his children:

It has been two months since the drainage appointment (Fig 38H) and

during this time bacteria and toxins would have penetrated the apical tissue
through the opened tooth. Both the patient and his relatives were informed of

the importance of patient cooperation and the guarded prognosis even after
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retreatment. They understood and chose to proceed with completion of 46
re-treatment.
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1) 46 Root canal retreatment
No local anesthetics. Rubber dam isolation. No cracks observed under

microscopic examination. Copious irrigation with NaOCl during cleaning
and shaping of the coronal and middle thirds of the canals, along with

intermittent use of ultrasonic irrigation. Once the irrigating solution became

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free of debris, a small 10 file was then used to peek through the RT of each
canal. Cleaning and shaping under the standard protocol completed and

master cone fit checked (Fig 38I). Warm vertical compaction obturation

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