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  Multiple CaOH appointments CASE

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From: Noemí Pascual
Sent: Thursday, May 03, 2007 2:37 AM
Subject: [roots] Multiple CaOH appointments CASE

I finished this patient today after three months. This patient was refered to me in February.
In January the referral did the RCT in the 42. His dx was pulpitis irreversible. 4 weeks after
the patient was symptomatic and painful. He did the retreatment in the 42. After 3 weeks the
patient was still symptomatic and painful. At that time the patient was referred to me.
Spontaneous pain, tenderness to percussion and palpation. No swelling, no sinus tract. I began
the second retreatment.

The patient was very upset and tired of being painful. Cleaning, shaping and copious irrigation.
CaOH as intracanal medicament for one week. After the first week she was still painful. But,
I find another canal. Cleaning, shaping and copious irrigation.CaOH as intracanal medicament for
3 weeks. The pain has decreased but not completely. No medication is needed for the pain.
Slightly tenderness to percussion and palpation. Cleaning, shaping and copious irrigation.
CaOH as intracanal medicament for 3 weeks more. Today the patient was very happy because at the
end the pain disappear. Lateral condensation with guttapercha buccal 55 diameter and lingual
45 diameter. AhPlus as sealer.

Should I have done anything else or different? Maybe less CaOH appointments?? - Noemí Pascual

Hi Noemi, Nice case! I think you handled the case very well, and this shows you that a single visit treatment is not the way to go in this type of cases. I never close a tooth that is symptomatic, and you see that you sometimes need more time or an extra appointment to discover additional anatomy. Two remarks: I would have taken some angled radiographs, to visualize the two canals, and I would have placed a post, or at least have left a post space, given the fact that this tooth will need a crown.- Marga