"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.
Not all teeth that look split are split; expect the unexpected!
Patient: 49-year-old male with controlled hypertension and hypercholesterolemia
Chief Complaint: Swelling on the cheek-side of his right lower molar
Dental History: The patient reported having had a bonded resin filling material having been placed in his mandibular right first molar approximately 6-12 months prior to the time of examination. His dentist had reported a crown fracture and on a recent cleaning visit buccal swelling was noted with a 12 mm sulcular defect communicating with the buccal furcation. The dentist was certain the tooth was split and referred the patient to the author because the patient insisted upon wanting to see if the tooth could be saved.
Long-term recall of internal perforation repair with amalgam
Patient: 38 year-old male in excellent health (1994)
Chief Complaint: Severe tooth ache
Dental History: The patient presented to the author in 1994 having had previous endodontic therapy on the maxillary right first molar (tooth #3) in 1990. Severe tooth pain had developed localized to the tooth 1 ½ weeks prior to the author examining the patient at which time the patient’s dentist had attempted endodontic retreatment. The attempted nonsurgical endodontic retreatment procedure failed to relieve the patient’s pain and the general dentist had performed an emergency surgical flap procedure. Antibiotics and narcotic analgesics had been prescribed and the patient was referred for endodontic consultation (1994)