Case # 2 :
Saving a “ hopeless tooth ” - A one year follow up
Clinician : Antonio Berto , DDS , Dallas , TX
Chief complaint : “ I had a root canal on that tooth and it keeps hurting , my previous dentist said there was nothing wrong with it . My new dentist recommended coming to see you to see if we can save the tooth .”
Exam / diagnosis : Tooth No . 31 was previously treated two years ago . Clinically the tooth did not respond to vitality test and was very tender to percussion and palpation on the area . Radiographically , a c-shaped root canal system can be noticed . There was a periradicular lesion associated to tooth # 31 . ( Fig . 1 ).
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Treatment : 1x1.8 ml carpule ( 36 mg ) 2 % Lidocaine , 1:100.000 epinephrine ( 0.018 mg ) was administered via inferior alveolar nerve block . After rubber dam placement , access was made .
Previous filling material was removed with headstrom files , and the access was extended unroofing the rest of the pulp chamber .
The exploration of all systems was completed with # 10 and # 15 Lexicon ® K-files and copious irrigation of 6.15 % sodium hypochlorite . The glide path management was done using Proglider ® rotary file .
The orifices were opened with the SX , and subsequently all canals were instrumented with Vortex Blue ® Files . The master apical size was # 40 / 06 . After shaping was completed , the EndoActivator ® was used to agitate the 6.15 % NaOCl . After rinsing out the NaOCl with sterile water , the canals were irrigated with QMix ® 2-in-1 which was also activated . All canals were dried with paper points . Interim medication with calcium hydroxide was used ( Fig . 2 ).
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The patient returned for a one year followup . The tooth responded within normal limits to all tests performed and radiographically the periapical radiolucency healed uneventfully ( Fig . 5 ).
It was highly recommended that the patient return to his general dentist to restore the tooth with a full coverage crown .
Pulpal diagnosis : # 31 Previously treated , symptomatic apical periodontitis
Treatment options : Root canal re-treatment , no treatment or extraction .
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The patient returned asymptomatic one week later . Obturation was completed using gutta-percha and Pro Root ® ES sealer to provide a natural seal by sealing the root biologically . ( Figs . 3 & 4 ).
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Dallas Endodontics
11910 Greenville Ave # 450 Dallas , TX 75243 ( 972 ) 644-1162 dallasendodontics . com
Highland Park Endodontics
7001 Preston Road , Suite 301-A Dallas , Texas 75205 ( 214 ) 528-ROOT ( 7668 ) highlandparkendodontics . com
Murat Ayik , DDS & Antonio Berto , DDS
Woodhill Endodontics
8335 Walnut Hill Ln # 125 Dallas , Texas 75231 ( 214 ) 691-5223 woodhillendo . com
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