Patient: Female, 28 years old
Diagnosis: Previously Treated and Asymptomatic Apical Periodontitis #30

I think one thing that we as endodontists need to start sharing with the world is more of our success cases. We need to share them with other specialists, general dentists and the public, so they can see just how beneficial root canal therapy can be, and how many teeth we can actually save!

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 another example of a case that proves that theory wrong. Wanna see? Let’s go!

The patient did not have any pain, but their 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.

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

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: you have to find all your canals, and 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 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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