Page 39 - The Beauty and Sorrow in Endodontics (Chapter 4 - Part 2)

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Inflammatory: 36 widened PDL around M and D roots
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Restorations: 25-x- 27 bridge, 36 Crown + D subgingival amalgam
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A Dx: 36
Pulpal: Necrosis
Periapical: Symptomatic apical periodontitis
P Discussed proposed treatment plan with the patient. Informed consent obtained to

proceed.

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1) 36 Root canal treatment
Local anaesthetics given. Multiple large restorations seen after crown removal

(Fig 49C). Rubber dam isolation. A significant amount of tooth structure had
been lost and replaced with restorative material under the crown (Fig 49D).

Root canal treatment was completed following standard protocols and no

cracks were observed. However, carious tooth structure on the disto-lingual
surface was present. To ensure no reinfection of the root canal system,

fiberposts and a resin core were placed first to ensure adequate coronal seal
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(Fig 49E). 36DL caries were then removed and restored (Fig 49F) and a
radiograph taken (Fig 49G). The in-house periodontist completed root planning

the same appointment and assessed if crown lengthening surgery was necessary
prior to the new crown placement (Fig 49H). The restoring dentist placed a

temporary crown and a panoramic radiograph was taken (Fig 49I). The
consensus amongst the dental team was that 36 did not require crown
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lengthening surgery but the importance of oral hygiene around the tooth was
reinforced to the patient.

2) Follow-up

6-weeks – The patient was happy with the treatment result and reported no
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discomfort. 36 was no longer sensitive to percussion or palpation
and its probing depths have returned to normal. Radiographic
examination showed that the apical lesion has healed and lamina

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dura has reformed around 36 (Fig 49J).
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3) 36 Crown (with restorative dentist)
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The restorative dentist completed laser gingivectomy around 36 to expose
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