Page 10 - The Beauty and Sorrow in Endodontics (Chapter 4 - Part 2)

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S Age/Gender: 30 F
CC: Referred by her dentist for 26 root canal retreatment
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HCC: The patient reported the initial root canal and crown placement were
completed 15 years ago. She reported dull aches with sensitivity to biting
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on the tooth for the past few years that has gotten worse within the past few
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days. The referring dentist had recommended extraction of 26 with
implant replacement, but the patient was hoping to retain the tooth.

O E/O: Slight tenderness to palpation of left TMJ and muscles of mastication
I/O: Overall healthy dentition and periodontal condition (Fig 45A)

26 crown with good marginal seal, STP (+), APT (+), DL PD 4-5mm
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Rad (Fig 45B, 45C):

Osseous: NSF
Inflammatory: 26 radiolucent lesion surrounding MB and DB roots
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Restorations: 26 crown, 36 and 37 shallow composite resin
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RCT: 26 (untreated MB2; over-instrumented P)
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Impacted teeth: 38 (horizontal)
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A Dx: 26
Pulpal: Previously treated
Periapical: Symptomatic apical periodontitis

Etiology: Cracked tooth?
** It was suspected that due to the positioning of the adjacent teeth ( 27 B tipped,
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# 35 L tipped), that most occlusal forces would’ve been applied on 26 and 36 (Fig
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45D), and therefore, 26 may have been cracked.
P Discussed proposed treatment plan with the patient. Informed consent obtained to

proceed.

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1) 26 crown removal (by referring dentist)
A radiograph was taken after the crown had been removed (Fig 45E): An
untreated MB2 canal was suspected; The pulpal floor did not seem to be overly

damaged; No posts were previously placed.

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