Case Studies.

Case #1

Tooth #31

Patient presented for evaluation of lower right side. Pt reports having pain to biting and chewing.

Tested teeth #’s 30, 31, 31 tested (+)perc, (+)biting, (-)palp, no response to cold.

Periradicular diagnosis
symptomatic apical periodontitis
Pulpal diagnosis
necrotic

Treatment : Root canal was completed on tooth # 31, anatomy was funky!

Case #2

Tooth #30

Patient presented for retreatment of tooth #30

(+)perc, (-)palp, previous RCT CBCT scan taken, (+)PAP MB root, short fill on mesial and distal roots

Apical diagnosis
symptomatic AP
Pulpal diagnosis
previously treated

Retreatment was completed in two visits, patient felt great after first visit.

Retreatment was uneventful.

Case #3

Tooth #09

Pt presented for retx # 9. CBCT scan taken, large PAP on 8 and open resorbed apex noted.

# 9 (+)perc, (+)palp, previous RCT, (+)PAP

Periradicular diagnosis
symptomatic apical periodontitis
Pulpal diagnosis
previously treated

Case #4

Tooth #30

Patient presented for retreatment # 30

(+CBCT scan taken, (+)PAP on both mesial and distal roots, missed DL canal # 30 (+)perc, (-)palp, previous RCT

Apical diagnosis
symptomatic AP
Pulpal diagnosis
previously treated

Retreatment was completed in two visits and was uneventful.

Case #5

Tooth #15

Patient presented for RCT # 15

# 15 (-)perc, (-)palp, no response to cold, (+)PAP

Apical diagnosis
asymptomatic AP
Pulpal diagnosis
necrotic

RCT was completed and was uneventful.

Case #6

Tooth #19

# 19 (-)perc, (-)palp, no response to cold

Apical diagnosis
symptomatic AP
Pulpal diagnosis
necrotic

RCT was completed in one visit using bioceramics. Treatment was uneventful.

Case #7

Tooth #29

A 12 year old boy presented with dad for eval # 29

# 29 (-)perc, (-)palp, lingering to cold, open apex

Periradicular diagnosis
normal
Pulpal diagnosis
irreversible pulpitis

Partial pulpotomy was completed, BC putty placed with IRM. Pt referred to his GP for permanent restoration. Pt was reevaluated in 6 month, root appeared more developed and slightly more closed than before, another reeval recommended in 6 months.

Case #8

Tooth #19

Patient presented for retreatment of Tooth # 19 Tooth # 19 tested (-)perc, (-)palp, previous RCT CBCT scan taken, (+)PAP distal root, short fill

Pulpal diagnosis
previously treated
Apical diagnosis
asymptomatic AP

Case #9

Tooth #30

Mr. P presented to our office for evaluation of tooth # 30. His dentist prepped his tooth and placed a temporary crown, pt was having slight sensitivity to cold.

(-)perc, (-)palp, lingering to cold

Pulpal diagnosis
irreversible pulpitis
Apical diagnosis
normal

Intresting findings: upon looking at the radiograph we notice very narrow and calcified canals in the mesiobuccal root, these can be very tricky to navigate, we must ensure a good glidepath in order to successfully instrument these canals! The canals are also curved.

Case #10

Tooth #29

A 14 year old female presented with parents for root canal treatment # 29. She had her braces removed recently and noticed a large, buccal swelling.

# 29 (+)perc, (+)palp, buccal swelling, no response to cold, (+)periapical lesion

Apical diagnosis
acute apical abcess
Pulpal diagnosis
necrotic

Treatment was completed in two visits. The goal of the first visit was to get the patient out of pain, I slightly instrumented and irrigated the canal; I placed calcium hydroxide and temporized with cotton pellet and cavit.

On the 2nd visit, she came back two weeks later, her swelling was gone and she was feeling better. We finished the case and the patient was very happy.


Some interesting facts:

The interesting factor was that apex was open and the tooth was necrotic. These are sometimes hard to manage because we don’t want to push our filling materials past the apex. I performed a procedure where I placed 3 mm of BC putty apically and then filled the rest of the canal with bioceramic sealer and Gutta Percha. I was happy that the material was contained and wasn’t pushed outside the apical segment. In order to contain the material, I always take a radiograph with a file and obtain my working length

Case #11

Tooth #14

Patient presented for RCT # 14, she states that she had trouble eating and sleeping for a few days.

# 14 (+)perc, (+)biting, no response to cold, (+)periapical lesion

Pulpal diagnosis
necrotic
Apical diagnosis
symptomatic AP

Root canal treatment was completed in two visits. On the first visit we cleaned and irrigated all the canals, calcium hydroxide was placed, tooth was temporized with cotton pellet and cavit. On the second visit, patient was asymptomatic, root canal was completed uneventfully.


Intresting findings:

DB canal was very curved and it was difficult to negotiate the curve, I used many instruments to establish a good glidepath and then I was able to instrument the canal uneventfully.

Endodontic Case Studies | Gentle Touch Endodontics