Difficult Isolation, Pure Dental Learning

Compromised Maxillary Molar: Should you Treat?

Should this tooth be retreated or extracted?

Patient: 76 year old female with controlled hypertension and arthritis

Chief Complaint: History of pain and swelling of one week duration (maxillary right posterior area)

Dental History: Root canal treatment on the maxillary right first molar (#3) had been performed by an endodontist 40 years earlier. Swelling and pain had developed a week earlier and was improving.

Significant Findings (Tooth #3): Moderate palpation and percussion sensitivity was observed upon testing. The radiographic series revealed a large diffuse radiolucency about the MB root and unfilled root canal systems with a parallel post having been placed in the palatal root. Periodontal probing depths were within normal limits with bleeding upon probing at the mesiolingual line angle area.

Difficult Isolation

Gemnation: Complicated Endodontic Treatment Management

Difficult Isolation

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.

Case Studies