PATIENT REQUESTS SECOND OPINION AS RELUCTANT TO LOSE AN ENDODONTICALLY TREATED TOOTH

A 55-year-old female patient was referred for a second opinion regarding the tooth 26.

The patient had previous root canal treatment one year ago and recently noticed a painful ‘lump’ above the tooth that had been treated. It was recommended that the tooth be extracted and replaced with an implant. The patient was reluctant to have the tooth extracted and hence was referred for endodontic specialist management. Clinically, there was a sinus-tract in the attached gingival and no signs of a radicular crack. The pre-operative radiograph suggested the possibility of perforation (figure 1).

Endodontic retreatment was commenced and a large perforation on the floor of the chamber was found on access. Although the working lengths could not be negotiated beyond the pre-existing lengths, the canals were thoroughly debrided and medicated with calcium hydroxide. Clinical improvement occurred rapidly after the first appointment, and in the final appointment, the canals were obturated with GP and AHPlus and the perforation was repaired (figure 2).

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Six month follow-up demonstrated radiographic healing with the patient remaining symptom-free (figure 3).
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ADDITIONAL ROOTS…

Mandibular premolar teeth are amongst the most difficult teeth to treat due to their complex root canal system. This is a case demonstrating a second mandibular premolar tooth with two roots.

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ADDITIONAL CANALS…

This case demonstrates the management of a mandibular molar tooth with three mesial canals. Up to 11% of mandibular molars have demonstrated three canals and up to 90% of these canals have intercanal communications, making disinfection a challenge.

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