Patient: 76-year-old woman with glaucoma
Chief Complaint: Toothache and Swelling (1990)
Dental History: Crowns (#’s 2, 3 and 4) and endodontic treatment on teeth #’s 3, and 4 performed 10 years earlier (1980). Endodontic access had been performed on tooth #2 without root canal filling material.
Significant Findings: slight percussion and palpation sensitivity associated with tooth #2 (1990)
Diagnosis: Incomplete root canal filling with necrosis and acute periradicular periodontitis (tooth #2, 1990)
Treatment Plan: Nonsurgical Endodontic Treatment (tooth #2, 1990)
Treatment Description and Special Considerations:
The patient returned for treatment of another tooth. A recall CBCT scan of her maxillary 2nd molar that that the author treated in 1990. A recall examination of #2 revealed no signs of endodontic pathosis and healthy support tissues. When the patient initially presented with an abscess, the #2 tooth was accessed and left open for drainage. When the patient returned 6 days later, the canals were obturated and endodontic treatment finished. It is interesting to note protocol changes that have occured over a couple of decades. No microscope was used on this case. The tooth was temporized after treatment with a cotton pellet and the patient was referred back to the restorative dentist for an amalgam core and a new crown. The adjacent two teeth were treated by a different local endodontist and those treatments appear successful as well. The teeth in this quadrant appear to have no recurrent endodontic disease.
Key Learning Points:
- A patient’s host defense can overcome some deficiencies in endodontic technique, but idealizing clinical technique to debride and seal the root canal system protects the attachement apparatus with more predictability. It is well established that microbial pathogens and mediators of inflammation are the etiologic agents of root canal disease.
- A recall CBCT scan can highlight anatomical root canal features that may explain routes of endodontic disease. Transmission. In this case the root anatomy of both maxillary molars was relatively simple without demonstrable lateral canals and confluent MB1-MB2 root canal systems
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