Gemnation presents unusual endodontic treatment challenges
Patient: 19 year old female with noncontributory medical history
Chief Complaint: Biting sensitivity
Dental History: The patient presented with occlusal caries in a groove of an anomalous molar (Tooth #15). The general dentist noted bleeding and a pulp exposure and referred the patient for endodontic evaluation and treatment. The patient reported having mild pain after the temporary pulp cap procedure, especially to biting.
Significant Findings (Tooth #15): The patient presented with an anomalous maxillary left second molar with a resin bonded filling in the mesiobuccal anomalous portion. The patient experienced moderate sensitivity to percussion, a normal response to cold thermal stimulation, normal mobility, and no palpation sensitivity. There was slight bleeding upon probing of the mesiolingual area but all probing depths were within normal limits. Access to the tooth was very limited due to a prominent coronoid process. A CBCT exam revealed a contiguous root canal system space in the anomaly extending near the coronal surface. The anomalous root canal system merged with the mesiobuccal root canal system and a very narrow mesiolingual fin seemed to merge with a single apical portal of exit. The DB and P systems did not appear to be anomalous.
hidden split in a tooth
Patient: 61year-old female with a history of colitis and hypothyroidism
Chief Complaint: biting and cold sensitivity
Dental History: The patient reported no recent dental procedures and started experiencing discomfort 5 days prior to the endodontic examination
Significant Findings: Severe localized percussion sensitivity was associated with the mandibular left central incisor (tooth #24). Sharp transient sensitivity was also noted with tooth #24 with the adjacent teeth responding within normal limits. Periodontal findings as well as all other clinical tests and findings were within normal limits. Fiberoptic transillumination of the tooth demonstrated a break of the beam through the incisal edge with the labial half of the crown remaining dark.
What is the reason for a vital pulp and a draining fistula?