Page 22 - The Beauty and Sorrow in Endodontics-Chapter 4 - Part 1

time. He was informed that all three lower front teeth will need to be

removed and replaced with implants and the treatment time could range

from six months to a year. He was speaking with a friend who had
recommended getting a second opinion.

O E/O: NSF to TMJ and muscles of mastication
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I/O: Sinus tract 41 buccal gingiva, suppuration upon palpation
# 32 – STP (+), APT (+), PDWNL, severe attrition, loss of restorative

material, food debris in canal access, discolouration (Fig 42B)
# 31 – STP (+), APT (+), PDWNL, severe attrition

# 41 – STP (+), APT (+), PDWNL, severe attrition
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#
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Rad (Fig 42C): 41, 31, 32 Periapical radiolucency
# 32 Severe root inclination
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# 41, 31, 32 all have ~10+ mm root structure in bone
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A Dx: 32
Pulpal: Previously treated
Periapical: Chronic apical abscess

#
#
31, 41
Pulpal: Necrosis
Periapical: Chronic apical abscess

Etiology: Endodontic origin, possible traumatic occlusion?
P Discussed proposed treatment plan with the patient. Informed consent obtained

to proceed. The patient recognizes this treatment is a last effort to retain the
teeth and accepted the time and cost of treatment knowing there’s a possibility

he may still need implants in the future.

1) Rx: Clindamycin 300mg BID for 7 days
#
2) 32 Root canal retreatment + 31, 41 root canal treatment (one day after
initial consultation)

Appt 1: Rubber dam isolation. Cleaning and shaping initiated, extra attention

paid at suspected lateral canal splits using ISO #10f and #8f with copious
#
ultrasonic NaOCl irrigation (especially in retreatment cases like 32).
Inter-appointment medication with NaOCl, cotton pellet and temporary
restoration placed (Fig 42D). The patient was instructed to finish the

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