Page 32 - The Beauty and Sorrow in Endodontics-Chapter 4 - Part 1

then taken (Fig 43L) and showed an irregular left condylar head (Fig 43M).

TMJ disorder was suspected and the patient was urged to see a TMJ

specialist for consultation and rehabilitation.
2) Follow-up

6-months – The patient reported no sensitivity to percussion or palpation on
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# 45 and 46. Probing depths and mobility of both teeth have
returned to normal. Radiographs confirmed reduction in the

periapical lesion size (Fig 43N, 43O).
2-years – No tenderness to TMJ or masticatory muscles upon palpation. The

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patient was grateful for the tips given to him for his TMD.
Radiographs showed continued healing of the apical lesion

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around 46 (Fig 43P, 43Q). Panoramic radiograph showed
arrested resorption of the two mesial roots and bone refill in the

furcation area (Fig 43R). 38 is horizontally impacted, but
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probing did not reveal deep pockets around 37D or any contact
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with 38 crown. The patient was instructed to pay extra attention
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to hygiene around 37 and return for regular follow-up and
hygiene appointments.

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3-years – The patient reported very happy with the function of 46 and was
grateful the team was able to help him retain the tooth.
Radiographic examination showed healing of the apical lesion

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and reformation of lamina dura around tooth 46 (Fig 43S, 43T).
Note Possible etiologies: poorly treated root canal; difficult pathogens; vertical root
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fracture; periodontal; or a combination of the above.

2 See “Working Length” & “Cleaning and Shaping” for more information on
cleaning and shaping of the canals and achieving patency.

3 In this case, since a mesial root resorption was noted, resulting in larger apical
openings, it is not recommended to place NaOCl as an inter-appointment

medication.
4 For patients with TMD, instruct them to alternate chewing between the two

sides (most patients have a preferential side); intermittent warm pack and

massage around the TMJ and masticatory muscles; avoid sleeping sideways;
avoid sudden jaw movements or big yawns, etc.

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