"The Devil is in the Details" - Ludwig Mies Van Der Roh
Meticulous debridement of the entire root canal system is important for a predictably successful endodontic treatment result.
Patient: 70 year-old female (time of treatment, 84 year-old at recall), history of breast cancer and managed hypertension, pacemaker (2018)
Chief Complaint: 10/2/2006: cold and biting sensitivity localized to the mandibular right first molar (#30)
Dental History: The patient presented with the said symptoms on 10/2/2006 after having a crown procedure started 3 months earlier, a temporary crown had been placed (#30).
Significant Findings (#30): Clinical examination revealed a 4mm periodontal pocket at the mesiolingual area, slight percussion sensitivity, and a sharp-transient response to cold thermal testing. The periapical and horizontal/bitewing radiographs demonstrated severe pulp chamber calcification, and an incipient furcation radiolucency.
Pulp and Periradicular Diagnosis (#30): Stressed pulp with calcific degeneration, acute periapical periodontitis.
Proper treatment of a gross perforation with a bioactive material can lead to remarkable healing.
Treatment Plan: Nonsurgical Endodontic Therapy and internal perforation repair (#26)
Special Considerations of Performed Treatment:
The first important consideration was elimination of pain which required palliative treatment (Ibuprofen and Acetaminophen), pulp extirpation, and management of the inflamed periradicular perforation site.
UPDATE: Recurrent Endodontic Disease After Initial Healing, 4 years later
Patient: 52 year-old (2014) male in excellent health
Chief Complaint: Patient reported a bump on the gums above his front upper tooth
Dental History: Patient reported a history of prior orthodontics as a child and previous endodontic treatment performed on the maxillary left and right central incisors in 1970 (teeth #’s 8 and 9). Surgical endodontic treatment had been performed years ago after a recurrent infection associated with the maxillary left central incisor (tooth #9)