MESSAGE BOARD 2 Post-Op Pain Persists 1 Month Following RCT Townies perform a postmortem on a patient's failed endo treatment Vislisel Post: 1 of 27 4/18/2023 In another topic, we were debating reasons for endodontic failure and I recently had a thought-provoking case on a healthy 42-year-old female patient that I thought might be worth discussing. I'll provide a thorough breakdown of my technique so we can pick at anything that could be a potential reason for this patient's persistent pain. * #14 asymptomatic irreversible pulpitis with normal periapical tissues during the initial visit. We elected to complete RCT in a single visit. * RD isolation. Complete caries removal resulted in an exposure. Unroofed the chamber and irrigated with Brasseler's Triton Solution before introducing any fi les into the canals. * Positive pressure 30 g side-vented needle irrigation was used throughout the procedure. Occasional rinsing from the air-water syringe for gross debris removal. * Four canals were present with the MB2 joining the MB canal. Cleaned and shaped using a blended crown-down/serial enlargement technique. * Patent in all three roots. Final apical fi le in the four canals was EdgeV-Taper HT 25.06v. Th is is an Edge Endo fi le designed from the original SS White V-Taper. * Regressive taper to save pericervical dentin, as opposed to progressive taper like a Protaper/WaveOnetype design. * After cleaning and shaping, the length was verifi ed with master cones while Triton was still in the canals. * Th e canals were then dried and obturated with BC Sealer and a single-cone technique. * After completion of RCT, the tooth was etched briefl y, followed by a thorough rinse/dry, and an RMGI orifi ce barrier was placed. Th e tooth was temporarily restored with a sterile sponge and Cavit. Th e patient was referred back to the referring dentist for defi nitive restoration, where they elected to move forward with a buildup and crown. Th e patient made a follow-up appointment to be seen one month after the treatment because the tooth was still painful to pressure, particularly noticeable when the referring dentist was trying to remove the temporary crown to put on the fi nal. Th e exam today showed a nice temp crown with well-adapted margins and no apparent infl ammation of the gingiva. Th e probings were normal. No contact on #14 in MI or excursive movements. Th e patient had discomfort to only fi nger pressure on the tooth. No palpation/percussion pain associated with #13 or #15; #15 had a normal response to cold. JUNE 2023 | 23 | DENTALTOWN.COMhttp://www.DENTALTOWN.COM