"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.
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)
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.