From: Toloumis Alexandros
To: ROOTS
Sent: Thursday, November 25, 2010 6:28 AM
Subject: [roots] What would you do in a case like this?

60 years old female patient, referred to me for the endodontic treatment both of 44 and 45.
These teeth where prepared for metal-ceramic crowns by the ref. before she presented to me
(both previously were the abutments of a fixed dental prosthesis that was ruined after losing
one of the other abutments of the prosthesis).

Dental history:

44 diagnosis: CAP, presenting carious procedures (even after the preparation for the crown) which where
removed prior to the endo treatment, periapical lesion during radiograph control were observed, tested
negative to thermal stimulation/electrical stimulation and slightly positive on vertical percussion,
palpation to the neighboring periapical gingival tissue also negative. Drilling test proved right about
the first diagnosis.

45 diagnosis: vital, positive (+++) considering that the tooth was already prepared and its vitality)
to thermal stimulation, no radiographic findings whatsoever as well as negative palpation/vertical
percussion. Patient never complained about this specific abutment. Drilling test was not performed.

After the anesthesia a rubber dam was placed to both premolars and the access cavity was prepared.

Cleaning and shaping of the root canals system with my standard protocol for 45:
shaping to a 35/.04 instrument as the MAF after careful gauging the foramen.
During instrumentation canal system was soaked with a 4.5% NaOCl and rinsed in between every file.
Finally a final rinse with 17% of EDTA was used for about 3 min.
Obturation was done by the CWC technique with a 40/.04 plugger to WL-3mm and backfill.
Radiograph shows the final situation.

Cleaning and shaping of the root canals system of 44 was slightly modified such as for necrotic
and CAP cases.
Shaping to a 50/.02 instrument as the MAF after careful gauging the foramen.
The only other difference in this protocol was the additional use of the CHX 2% for 3 min.
as the final rinse instead of EDTA. Obturation was carried out as in the above case.

After the final radiograph i am asking myself should i reopen the 44 for a better backfill or
leave it as it is with this nasty-placed void there? What would you do my fellow colleagues?
Any advice would be much appreciated.

Thank you in advance for your precious time to answer to this.
I hope i did not bragged too long about this one...but i'm in agony what should i do? - Alexandros Toloumis


P.S: i managed to obturate a lateral canal there at the apical third of the 44 during the downpack
but how did i miss that void there is beyond me!