Page 27 - The Beauty and Sorrow in Endodontics (Chapter 4 - Part 2)

procedure, microscopic examination under various magnifications and angles

were performed to assess the extent of the existing cracks. The mesial and distal

crack lines did not extend into any canal or connect with each other along the
pulpal floor (Fig 47H). The patient was informed that the cracks seem to be

limited to the coronal structure and the tooth may have a second chance at being
retained after all. Obturation was then completed with warm vertical

compaction technique (Fig 47I, 47J), and a fiberpost with resin core buildup was

completed to ensure coronal seal (Fig 47K).

2) Follow-up
1-month – The patient reported no discomfort and an Emax crown had been

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fabricated for 27.
6-months – The patient has been asymptomatic and was happy with the

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treatment result for 27. She agreed to a panoramic radiograph along
with two posteriors bitewings (Fig 47L, 47M, 47N). Intraoral
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examination revealed normal percussion and palpation to 27 and the
probing depths remained at 4-5mm at the mesiobuccal and
distolingual pockets while all others were normal. Even though

palpation of her TMJ and muscles of mastication elicited no

significant discomfort, generalized attrition was evident on both
upper and lower posterior teeth, and an occlusal appliance was

recommended to prevent future damage.
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2.5-years (6-months after 28 extraction) – The patient returned complaining of
occasional swelling around 27. A sinogram with gutta percha cone
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through the opening of the sinus tract points to 27 as the culprit (Fig
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47O).

3) Examination of 27
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Intraoral examination showed 27 was once again sensitive to percussion
and palpation and the probing depths were 6-7mm at the mesial and 8-9mm at

the distal. The perio pockets were irrigated with 3% H2O2, and white bubbles

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