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Emergency with Multiple Tooth Pain Factors

Terry Pannkuk, DDS, MScDDiagnostic Puzzles, Complications: Advanced Management, Difficult Isolation, All by Date


CBCT scan taken after the first endodontic treatment visit. Note the retained portion of the #17 crown near the mandibular nerve (5/5/2015)

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How do you handle multiple causes of dental pain on an emergency?

Patient: 35 year-old male with a noncontributory medical history

Chief Complaint: Dull ache in the mandibular left posterior area disrupting his sleep and work

Dental History: The patient reported having had a ceramic inlay placed in the mandibular left second molar (#18) within the last 5 years with a history of a “near” pulp exposure, or pulp cap. He had been examined by an oral surgeon who recommended removal of the impacted mandibular third molars. He reported recent pain which had increased to a current dull ache.

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The most obvious problem was the portion of #17 remaining after the surgical removal. I would have removed the remaining piece at the first convenience. BTW, beautiful endo!

Thanks John, I was hoping there would be a discussion about the retained portion of crown. Herd (1973) demonstrated that it is highly unusual for a retained root to show histological evidence of pathosis. This finding has been fairly consistently shown by later groups as well. Given the fact that this is a crown portion with no root canal system space, it is even more unlikely to be a problem if left. The healing of the socket was interestingly delayed, but the risk of damaging the approximating mandibular nerve unnecessarily is probably the reason it was left. Access was very challenging and difficult to this area. An "ugly" treatment success is still better than a "pretty" failure.

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