Page 38 - The Beauty and Sorrow in Endodontics-Chapter 4 - Part 1

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S Age/Gender: 40 M
DH: 15 removed for orthodontic treatment. 15 implant placed due to excess
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spacing after ortho.
CC: “My wife says I have bad breath and my tooth hurts”

HCC: The patient reported when he got the filling done on teeth 14 and 16, the
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dentist had told him the cavities were deep and he may need root canal

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treatment in the future. He’s noticed intermittent swelling around 16 but
never sought treatment for it as it wasn’t too bad. A few days ago, when
the swelling came back and the pain became unbearable, he went to see

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his family dentist, who informed him that 16 needed to be removed as
soon as possible to prevent the infection from spreading to 15 implant.
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O I/O: Sinus tract on the mesiobuccal gingival around 15 (Fig 44A) + distopalatal
gingival of 16 (Fig 44B)
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# 16 STP (+), APT (+), PD WNL

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Rad: Sinogram with gutta percha cone points to 16 (Fig 44C)
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A Dx: 16
Pulpal: Necrosis

Periapical: Chronic apical abscess
P Discussed proposed treatment plan with patient, and consent was given to

proceed.

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1) 16 Root canal treatment
Appt 1: No local anaesthetic. Rubber dam isolation. No visible cracks

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observed on 16 under the microscope (Fig 44D, 44E). Bad odour along with
suppuration within the pulp chamber was present as soon as access cavity was
established (Fig 44F). The tooth was confirmed to be necrotic. MB1, DB, P

canals were successfully cleaned and shaped, however, MB2 could not be

negotiated (Fig 44G). Ultrasonic vibration and copious NaOCl disinfecting
solution were utilized throughout treatment. Interappointment medication

with NaOCl. Cotton pellets placed and the access double sealed with Cavit +
composite resin (Fig 44H, 44I)

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Appt 2 (one week later): The patient reported being able to function on 16, 3

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