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Unresolved Symptoms for Years

Terry Pannkuk, DDS, MScDDiagnostic Puzzles, Complications: Advanced Management, Missed Canals, Retreatment Strategies, Dismantling, All by Date


3/7/2017: Preoperative radiograph showing periapical radiolucencies and a mid-root radiopacity associated with the mesial root (#19)

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Unresolved symptoms for years suggests a wrong diagnosis

Patient: 64 year-old female in good health

Chief Complaint: toothache and swelling in lower left back jaw

Dental History:

The patient reported having had root canal treatment on her mandibular left first molar (#19) 5 years prior to the author’s examination. Swelling had persisted and surgical endodontic retreatment had been performed a few months after the initial endodontic treatment. In 2013, the previous treating endodontist diagnosed a necrotic pulp and acute periradicular periodontitis associated with the mandibular left second molar (#18) and associated the continued swelling and non-healing of the #19 periapical bone to the pathosis of #18. The patient continued with a toothache and swelling until it worsened in 2017 and the patient sought the author for a second opinion.

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