Claudia Hoffman
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34-YEAR-OLD MALE presented to our office with the chief complaint “My tooth
hurts off and on.” His dental history revealed that endodontic therapy
had been performed on tooth #6 two years earlier, due to a carious lesion.
The tooth was still symptomatic after the first root canal therapy had
been completed. Surgical endodontic therapy was performed due to
the persisting problem. The symptoms had never completely subsided.
The intra-oral and extra-oral clinical exams were
within normal limits. Tooth #6 was sensitive to percussion and palpation.
The tooth had no mobility or periodontal pocketing. Tooth #6 had
endodontic therapy, which appeared adequate radiographically, and an amalgam
retroseal. In addition, #6 had a screw post and the tooth had been
restored with a composite that appeared to be leaking. There was
no fracture evident radiographically or clinically.
The treatment related to #6 was failing, and possible
etiology was a microfracture or endodontic therapy failure due to orthograde
root filling contamination, questionable apical seal, or microleakage from
the coronal seal.
Factors involved with a failure in endodontic surgery
can include inadequate root end management, leakage, poor orthograde treatment,
incomplete removal of cyst lining, and failure to recognize root fracture.
The patient was given possible treatment plans:
retreatment and observation, retreatment and apicoectomy, or extraction.
The patient was advised that the prognosis for the tooth was guarded unless
extraction was the chosen option. After careful consideration, the
patient decided to try retreatemnt and observation.
The post and gutta percha were removed under rubber
dam isolation. The amalgam retro-seal was visualized under the microscope
and the root was checked for fractures. The canal was irrigated with
sodium hypochloride and chlorohexidine. After careful instrumentation
to the retroseal, calci-um hydroxide was downpacked into the canal.
The patient returned after ten days and was still
symptomatic. The tooth was instrumented and irrigated again and packed
with calcium hydroxide. After another ten days, the patient was contacted
and stated that all the symptoms had disappeared. The treatment plan
at this time is to obturate the canal and temporize the tooth for three
to six months under observation.
April - June 2005
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The patient
was given possible treatment plans: retreatment and observation, retreatment
and apicoectomy, or extraction.
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