This page features a case/procedure from the office that you might find entertaining. It is meant to showcase what the specialty is capable of delivering, given the advancements in technology and evidence-based techniques. Each month I will try to present a patient's treatment that reflects that concept. (Strict anonymity is to be maintained, for patient privacy reasons)


This patient presented for consult on tooth #18; there was sensitivity and mild discomfort / pain that has persisted for the last 3 months. RCT was completed 2 years ago; retreatment 1 year ago to attempt to resolve the symptoms. the patient was advised to have tooth extracted as it was probably fractured.


                        Pre-operative radiograph #18 ReTx                            Pre-operative radiograph #18 ReTx

A Cone Beam CT scan was exposed of the area of #18-21. Scrolling through the 75µ slices, a small radio-opaque streak was seen to exit from the mesial canal toward the lingual aspect of that root at the level of the CEJ minus 4 mm (arrow, Scan 1) in the axial view. This finding was corroborated by scrolling in the coronal views (arrow, scan 2) and using a special color template in the 3-D sectioning view (arrow, scan 3).


                            CBCT scan #18, scan 1: Axial view                                CBCT scan #18,scan 2: Coronal view


                                 CBCT scan #18, scan 3: Custom color 3-D axial section (Mandibular Nerve in blue)

The gutta percha was removed, and the ML canal was located as a bifurcation 5 mm below the floor of the chamber. The canals were instrumented, and Ca(OH)2 placed as an intra-canal medicament. The patient was appointed two weeks later for completion; she was asymptomatic.


                                          Files in ML/MB canals                                         Gutta percha removed from all canals



                                Post-Operative radiograph #18A                            Post-Operative radiograph #18B

(Referring Doctors Home)