Page 39 - The Beauty and Sorrow in Endodontics-Chapter 4 - Part 1

days after the last appointment. Intraoral examination showed shrinkage of

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the sinus tracts. The patient reported slight sensitivity to percussion on 16.
Rubber dam isolation. Cleaning and shaping completed. MB2 could not be
negotiated, therefore, extra steps were taken to ensure proper disinfection of

MB1 with NaOCl and ultrasonics. Canals were then dried with paper points.
Warm vertical compaction obturation completed (Fig 44J). Fiberposts

cemented in each canal with dual cure resin cement (Fig 44K) and core

buildup completed to ensure coronal seal. Rubber dam removed and
occlusion adjusted before a final radiograph was taken that shows properly

overfilled sealer at each canal exit (Fig 44L). An enlarged image of the apical
portion shows the MB2 that split from MB1 mid-root had been sealed with

sealer (Fig 44M). This demonstrates that the canal can be disinfected with
NaOCl and ultrasonic activation even without being physically shaped by a

file. The removal of debris and necrotic pulp in MB2 allowed for the sealer

and some heated GP to flow into the canal and properly seal it from further
infection.

2) Follow-up

3-months – The patient reported no discomfort or swelling since treatment

completion. Percussion, palpation, and probing depth were all
normal on 16. A radiograph confirmed reduction in the periapical
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lesion size (Fig 44N). The overfilled sealer has been slowly
resorbed by the body as the lesion heals (Fig 44O). Crown

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placement on 16 was recommended.
6-months – 16 tested normal to percussion and palpation. TMJ examination
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was conducted and revealed no concerns. The bitewing shows the

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ideal shape and fit of 16 crown (in comparison to 15) (Fig 44P).
A periapical radiograph shows continued healing of the lesion
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around 16, resorption of the overfilled sealer as well as lamina
dura reformation were also observed (Fig 44Q). This confirms that

# 16 has been successfully treated and retained without affecting

# 15 implant.
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2-years – The patient complained of difficulty flossing between 14, 15, and
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