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From: Richard Schwartz
Sent: Saturday, April 14, 2001 07 32
Subject: A good case on Good Friday
We were just getting ready to go home early this afternoon when we got a
call from one of the local oral surgeons asking us to see his patient.
The patient was a 20 y/o male who had been in acute pain for 2 weeks since
having his wisdom teeth removed. The oral surgeon had initially thought
the patient had a dry socket and had packed it several times. As the pain
continued into the second week he concluded that probably wasn't it. #18
was very tender to percussion and hyper-responsive to cold with lingering
pain. #19 had a 6 month old root canal done by a gp who does endo in other
people's offices. It was asymptomatic. To make it more interesting, the
patient could only open about an inch at the incisors.
I prepared the mesial canals entirely with rotaries. I did the initial
preparation of the distal canal with rotaries to about size 25, but then
chickened out and enlarged it to 35 and did a step-back with hand
instruments. There was a lot of hemorrhage in the distal canal during
instrumentation, even though I never was able to achieve patency at the
apex. I figured there were some fairly large lateral canals and, sure
enough, there were. It is hard to appreciate from the xrays, but the
distal canal also curved sharply to the buccal. - Rick Schwartz
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Photos courtesy of Rick Schwartz - www.rxroots.com
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