Page 32 - The Beauty and Sorrow in Endodontics (Chapter 4 - Part 2)

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S Age/Gender: 40 M
CC: “I want a second opinion”

HCC: The patient reported throbbing pain on the lower left posterior that started a
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while ago, his dentist had recommended root canal treatment for 37 but
discovered a crack during treatment and has then recommended extraction
with implant replacement. The patient wanted a second opinion to see if

there’s a chance he can retain the tooth. The patient had brought in the

radiograph taken at his dentist, which shows an apical radiolucency around
# 37 (Fig 48A). The dentist also took a photo after the removal of the

amalgam restorations that shows a distal crack (Fig 48B). The patient
reported no history of pain or discomfort to biting.

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O I/O: 37 STP (+), APT (+), DB/L PD 4-5mm
Rad (Fig 48C, 48D):

Osseous: NSF

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Inflammatory: 37 apical radiolucency
Restorations:26O, 27O, 36O, 35MO all far from the pulp

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RCT: 37 pulpotomy, C-shaped D canal
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A Dx: 37
Pulpal: Previously initiated

Periapical: Symptomatic apical periodontitis
P Discussed proposed treatment plan with the patient. Informed consent obtained to

proceed.

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1) 37 Root canal treatment and assess extent of crack
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Local anaesthetics given. Rubber dam placed. Bone sounding 37 straight distal
revealed 6-7mm. Access cavity completed. Cleaning and shaping completed

along with copious ultrasonic-activated irrigation. Warm vertical compaction

obturation. The distal and lingual canals were connected and became a C-shaped
canal; the mesial canal was separate (Fig 48E). Examination under high

magnification showed that the distal crack did not extend into the distal canal
(Fig 48F). Coronal seal was completed with dual-layered temporary restoration

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