Page 14 - The Beauty and Sorrow in Endodontics-Chapter 4 - Part 1

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S Age/Gender: 60 F
CC: “I want a second opinion to see if I have to remove my teeth and get implants”
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DH: 5 years ago – 35 root canal treated due to pain. Splinted crowns 34- 35
placed for support as 35 did not have enough tooth structure according to
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the previous dentist.
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3 months ago – 36, 37 implant surgery
HCC: The patient reported swelling on the lower left gingiva that started 2 weeks

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ago. She had gone back to see the implant surgeon to have the 36, 37
implants evaluated in fear of implant rejection. The surgeon completed
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clinical exams and took a radiograph (Fig 41A) then told her that 34 and
# 35 were the ones infected and needed to be removed to prevent the

infection from spreading to nearby implants. He recommended two more
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implant replacements for 34 and 35.
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O I/O: 34 STP (+), APT (+), PD WNL
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35 STP (++), APT (+), PD 7 mm (DB/L)
Abundant food debris between 34/ 35 crowns
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The patient had consented to allow the author to remove the splinted crowns for
further evaluation. The crowns were removed via ultrasonic and can be used as
temp restorations after root canal treatment.

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Rad: 35 RCT obturation off-centered (Fig 41B)
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A Dx: 35 Pulpal: Previously treated
Periapical: Chronic apical abscess
# 34 Pulpal: Necrosis

Periapical: Chronic apical abscess

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Etiology: Possible untreated canal in 35
P Discussed proposed treatment plan with the patient. Informed consent obtained to

proceed.
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1) 35 Root canal retreatment
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Rubber dam isolation. No cracks observed on 35. Pus drainage once the
old and loosened obturation material removed. Cleaning and shaping performed
following standard protocol. Master cone fit radiograph (Fig 41C) showed that

the GP cone is off-center at the apical portion, indicating possible split canal at
that location. ISO #8 and #10 files along with ProUltra #6 and #7 used along

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