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Endo tips    Better Endo    Endo abstracts    Endo discussions

Necrotic CPP with symptoms - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are - www.rxroots.com
From: Fred Barnett
To: ROOTS
Sent: Friday, March 05, 2010 11:29 PM
Subject: [roots] 1 yr f/u re-tx of my own case....2nd year resident case

from 2nd year resident.....

Enjoy!

Here's the 1 yr follow up on a case I did.  Healing in progress.  The history below is what I had sent out
last year with the case.  Pt is asymptomatic now and doing well, except he still hasn't gotten anything
restored.  What a pity!

Pt came in with pain on #31.  Necrotic/CPP with symptoms. Bridge from #29-31 with recurrent caries.
Discussed sectioning bridge, single crowns on #29 and 31 (after tx #31 and re-tx/possible apico #29) and implant #30.
Don't like the bone too much in area of #30, but will re-eval for implant at next visit.

Started tx #31.  Upon access, there was exudate present.  Managed to separate a #10 file with the M4 in MB
and it took me an entire appointment to get it out.  Used 'tube and glue' method.

Pt called back 2 days later in "excruciating pain and swelling" in the submandibular region.  Rx Pen VK.
It wasn't sufficient.  Pt called back the following day reporting increased swelling "the size of a golf ball".
Pt wasn't able to come in that day.  Dr. Trope advised to add Metronidazole to the Pen VK to take concurrently
and I asked him to come in the following day and go to ER during the night if impaired with breathing.

At the second visit (the re-tx visit) there was still exudate being expressed from the mesials. Unable to dry.
Placed new Ca(OH)2 after debrid/disinf.

Pt came in for 3rd appt.  No exudate, no pain; completed case.  There was quite a bit of troughing in coronal
portion of MB to access the separated file, as you can see from the final radiograph.

Any comments/suggestions are welcome! - Melissa"

Protaper flaring
6 yr old Empress
Cvek pulpotomy
Middle mesial
Endo misdiagnosis
MTA retrofill
Resin core
BW importance
Bicuspid tooth

Necrotic #8 treatment
Finding MB2 / MB3
Deep in a canal
Broken file retrieval
Molar cases
Pushed over apex
MB2 and palatal canal
Long lower third
Veneer cases
CT Implant surgury

Weird Anatomy
Apical trifurcation
Canal and Ultrasonics
Cotton stuffed chamber
Pulp floor sandblasting
Silver point removal
Difficult acute curve
Marked swelling
5 canaled premolar

Sealer overextension
Complex anatomy
Secondary caries
Zygomatic arch
Confluent mesials
LL 1st molar (#19)
Shaping vs Cleaning
First bicuspid
In Vivo mesial view
Inaccesible canals

Premolar 45
Ortho and implant
Radioluscency
Lateral incisor
Obturation
Churning irrigant
Cold lateral
Tipped to lingual
Acute pulpitis images

Middle distal canal
Silver point
Crown preparation
Epiphany healing
Weird anatomy
Dual Xenon
Looking for MB2
Upper molar resorption
Acute apical abcess
Finding MB2

Gingival inflammation
Irreversible pulpitis
AG BU ortho band
TF Files
using TF files
Broken bur
Warm technique
Restorative prognosis
Tooth # 20 and #30

Apical third
3 canal premolar
Severe curvature
Interesting anatomy
Chamber floor
Zirconia crown
Dycal matrix
Cracked tooth
Tooth structure loss
Multiplanar curves