Page 31 - The Beauty and Sorrow in Endodontics-Chapter 4 - Part 1

Etiology: Unknown 1

P Discussed proposed treatment plan with the patient. Informed consent obtained

to proceed.
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1) 46 Root canal retreatment
Appt 1: Rubber dam isolation. Occlusal access cavity through the existing
composite resin. It is crucial to not damage the pulpal floor as it provides the

road map to canal orifices. The untreated DL canal orifice was identified (Fig

43C), which was close to where the previous dentist had been searching
(now covered with the white material) (Fig 43D). After removal of all old

obturation material, both MB and ML had pus drainage and their canal
apicies were larger than ISO #100. On the other hand, patency could not be

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achieved at the DB canal. Since there were evidence of external root
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resorption on the M root, <1% NaOCl solution was used for irrigation.
Canals were dried with paper points once there was no longer pus drainage.

Cotton pellets placed, and access double sealed with Cavit and composite
resin (Fig 43E).

Rx: Clindamycin 300mg TID for 7 days

Appt 2 (one week later): The patient reported disappearance of the abscess 3

days since the last appointment and he had been able to function on the tooth
since day 5. Intraoral examination showed healing of the gingival tissue with

the disappearance of the abscess (Fig 43F, 43G, 43H, 43I).The patient
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reported slight sensitivity to percussion on 46 but no longer at 45. The
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probing depths around 46M has reduced to <5mm. This confirmed the
etiology of the apical lesion had originated endodontically, likely from the
inadequate previous treatment.

Rubber dam isolation. Cleaning and shaping completed. Gelfoam and MTA
placed at the apical 3mm of MB and ML canals. Warm vertical obturation

(Fig 43J). Fiberpost with resin core (Fig 43K). Reinforced oral hygiene.
The patient also complained that since the implants were placed, he hasn’t

been able to function on the left side. He reported discomfort during

palpation of bilateral TMJ and masticatory muscles. His jaw also deviated in
a S-shape motion during opening and closing. A panoramic radiograph was

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