Page 47 - The Beauty and Sorrow in Endodontics-Chapter 3

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2) 46 Root canal treatment (2 weeks after hygiene)
Appt 1: No local anaesthetics. Rubber dam isolation. Occlusal access completed

without patient discomfort. The pulp chamber flushed with 5.25% NaOCl.
Individual canals cleaned and shaped to the middle third utilizing the envelope

of motion. Frequent irrigation with NaOCl solution and ultrasonic tips. 2.5%
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NaOCl was then used during cleaning and shaping to just short of the tWL .
<1% NaOCl was used when a small file peeked through the RT to obtain

patency. Cleaning and shaping then completed for all four canals. Final
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ultrasonic irrigation with <1% NaOCl. Intracanal medication with <1% NaOCl.
Cotton pellets and temporary restoration placed. A radiograph taken to ensure
proper seal of the temporary restoration (Fig 39J). 6 The patient was informed

to return in one week for completion.
Rx: Clindamycin 300mg TID for 7 days.

** The patient reported at the next appointment that he never took the

Clindamycin since he felt no discomfort after the initial appointment.

Appt 2: No local anesthetics. Rubber dam isolation. Temporary restoration and
cotton pellets removed and pus drainage observed in the DL canal. Cleaning and

shaping completed in all canals under copious NaOCl irrigation again. When
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double checking the DL canal once again with a hand-used NiTi file , the tip
broke off in the canal. After considering the risks and benefits of retrieving the

broken file, the author had decided to leave the file and continue with
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obturation. Ultrasonic irrigation with QMix completed and master cones were
selected for each canal (Fig 39K, 39L). Final irrigation with QMix and the

canals were then dried with paper points. Warm vertical compaction obturation
(Fig 39M). Fiberpost and resin core completed. Final radiograph taken (Fig

39N). Discussed the broken file with the patient and stressed the importance of
returning for routine follow-up. The patient was informed that surgery to

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remove the DL root may be indicated if healing is suboptimal. If 46 is healing
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well, then a crown would be recommended. It was also recommended that 48
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be extracted to prevent future complications with 47 (see “case 96”).
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