I really believe dentists and dental specialists like endodontists really need to start sharing more of our success cases with the world. That way, everyone will see just how beneficial root canal therapy can be, and just how many teeth can actually be saved. (And if you want to experience more successes, I definitely suggest you enroll in E-School: Everyday Endo Made Easy!) Today I want to share a root canal recall case that went well.

So many clinicians get scared when they see a large lesion, and they automatically assume the tooth is not restorable or that the tooth is cracked. Well, here is a case that proves that theory wrong. Wanna see? Let’s go!

A Root Canal Recall Tooth Story

For context, my patient is a 28-year-old female. She did not have any pain, but her general dentist spotted something suspicious on the radiograph.

A periapical radiolucency was identified on the distal root of tooth #30. The patient had no response to cold and no pain to percussion on tooth #30.

So, her diagnosis was Previously Treated and Asymptomatic Apical Periodontitis #30. (Need help with pulpal and periapical diagnosis? I’ve got you covered.)

Since it’s a retreatment, I always take a CBCT. Here it is:

Now you can really appreciate the size of that radiolucency, and it does NOT make me want to abort treatment on this tooth. Instead, I want to know what is causing this radiolucent area. Even though the root canal appears to be well done on the radiograph, the axial slice tells the full tooth story.

The disto-lingual canal was missed and never treated. In these situations I like to tell my patients that their infection is as old as the root canal, since the original bacteria was never removed. Check out the coronal view. It clearly shows the missed canal as well.

So, I retreated this tooth in two visits, medicating it with calcium hydroxide for several weeks. This is what the tooth looked like in the end.

I also ended up treating tooth #29 as well since there was a carious pulp exposure on that tooth.

The patient came back for her one year recall and this is how she looked.

The bone looks great, but since the lesion in the initial periapical radiograph didn’t look as large as in the CBCT, the patient wanted to see the 3D version. So, we decided to compare apples to apples and take another CBCT at her recall visit and this is what we saw…

That bone is back, baby!! Remember, it always goes back to those TWO cardinal rules of endodontics: 1. Find all your canals, and 2. Get to the end of every canal. Otherwise, your stuff just isn’t going to work.   

Let’s look at those images side by side!

This patient was so happy with the outcome, and she was stoked to be able to see it with her own eyes!

Do you ever do this with your patients? Show them exactly what has happened in their body?  In my experience, people WANT to know and they LOVE seeing the evidence.

-Sonia

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