Case Report 2

Patient Information: 21 year old female referred for endodontic therapy of tooth #3.

Chief Complaint: The patient is asymptomatic and states, "My dentist sent me her for a root canal."

Past Medical History: The patient denies any significant medical history.

Past Dental History: The patient has received routine dental treatment for the last 15 years.

Present Dental History: She is currently under the care of a general practitioner. Tooth #3 was treated for deep decay resulting in a carious exposure. A temporary restoration was placed, and the patient was advised the tooth required endodontic therapy.

Clinical Evaluation: No swelling was noted extraorally or intraorally. Tooth #3 was asymptomatic. No mobility was noted. The tooth was not sensitive to percussion, and probing depths were 2 to 4 mm. A temporary filling was noted. Radiographic evaluation was within normal limits.

Pretreatment Diagnosis:
Pulpal: Irreversible Pulpitis secondary to caries
Periapical: Normal

Treatment Plan: Non-surgical root canal therapy #3.

Clinical procedure:

Visit 1 — 1/11/01

  1. Preoperative radiograph taken.
  2. Informed Consent gained.
  3. Topical, 36 mg lidocaine with 0.18mg epinephrine administered by buccal and palatal infiltrations.
  4. Rubber dam isolation.
  5. Tooth taken out of occlusion.
  6. Temporary restoration removed, revealing pulpal exposure of mesiobuccal pulp horn.
  7. Access gained.
  8. Working lengths obtained radiographically.
  9. Full instrumentation using Profile NiTi rotary files, NaOCl, Glyde, and K files.
  10. Cotton placed in the chamber, and the tooth sealed with Cavit.

Visit 2 — 1/17/01

  1. Topical, 36 mg lidocaine with 0.18mg epinephrine administered by buccal and palatal infiltrations.
  2. Rubber dam isolation.
  3. Cavit, cotton removed.
  4. Patentcy confirmed with 20 K file.
  5. NaOCl irrigation.
  6. Canals dried with paper points.
  7. Obturated all canals (gutta percha, Roth's sealer, warm vertical condensation).
  8. Cotton and Cavit placed.
  9. Post-operative radiograph taken.
  10. Post-operative instructions given, and patient was referred to her general practitioner for the final restoration.

Visit 3 — 2/26/01

  1. Patient presents for emergency visit and complains, my dentist did a filling on the tooth behind the tooth you treated, and it hurts.
  2. Tooth #2 tender to percussion, thermal testing yields normal responses (compared to other teeth in quadrant) with no lingering sensations.
  3. Articulating paper reveals tooth #2 is in hyperocclusion.
  4. Occlusion on #2 was reduced.
  5. Patient advised to wait to determine if symptoms get better or worse, and follow up in 3 to 4 weeks.

Chief Complaint: Patient presents and states, "it's getting worse."

Clinical Evaluation: No swelling was noted extraorally or intraorally. Tooth #2 is tender to palpation, hypersensitive to cold, with lingering sensation for 15 seconds. Probing depths were 2 to 4 mm, no mobility was noted. An amalgam filling was noted which radiographically approximated the pulp.

Pretreatment Diagnosis:
Pulpal: Irreversible Pulpitis secondary to caries
Periapical: Acute Apical Periodontits

Treatment Plan: Non-surgical root canal therapy #2.

Visit 4 — 3/12/01

  1. Preoperative radiograph taken.
  2. Consult with patient's general practitioner to confirm treatment plan.
  3. Informed Consent gained.
  4. Topical, 72mg lidocaine with 0.36 mg epinephrine administered by buccal and palatal infiltrations.
  5. Rubber dam isolation.
  6. Tooth taken out of occlusion.
  7. Amalgam restoration removed, a pulpal exposure was noted on the floor of the preparation.
  8. Access gained.
  9. Pulpectomy performed.
  10. Irrigated with sodium hypochlorite
  11. Cotton placed in the chamber, and the tooth sealed with Cavit.

Visit 5 — 3/15/01

  1. Patient presents complaining of, "throbbing pain."
  2. Topical, 36 mg lidocaine with 0.18mg epinephrine administered by buccal and palatal infiltrations.
  3. Rubber dam isolation.
  4. Working lengths obtained radiographically.
  5. Full instrumentation using Profile NiTi rotary files, NaOCl, Glyde, and K files.
  6. Cotton placed in the chamber, and the tooth sealed with Cavit.

Visit 6 — 4/6/01

  1. Patient presents asymptomatic.
  2. Topical, 36 mg lidocaine with 0.18mg epinephrine administered by buccal and palatal infiltrations.
  3. Rubber dam isolation.
  4. Cavit, cotton removed.
  5. Patency confirmed with 20 K file.
  6. NaOCl irrigation.
  7. Canals dried with paper points.
  8. Obturated all canals (gutta percha, Roth's sealer, lateral condensation).
  9. Cotton placed in the chamber, and the tooth sealed with Cavit.
  10. Post-operative radiograph taken.
  11. Post-operative instructions given, and patient was referred to her general practitioner for the final restoration.

This case was diagnosed and treated by:
Dr. Michael E. Newman, second year resident
Post-Graduate Endodontics