Dentaltown June 2023 - 24

MESSAGE BOARD 2
CBCT was made and interpreted:
* No isolated crestal bone defects were indicative
of a crack.
* All major canal anatomy was treated
adequately.
* #14 root apices are in close approximation
to the sinus.
* No defi nitive PARL present.
* Slight sealer extrusion and slight thickening
of the sinus membrane.
rtcnls
Post: 2 of 27
4/19/2023
Th e only thing that stands out here is the fi nal
25.06 in the palatal canal. Having been through
enough pendulum swings of large vs. small preparations
and having my own similar cases, my
suspicion is that the palatal canal has not been
mechanically cleaned enough and is the likely
source of continued symptoms. Could be debris in
any of the roots, though. Th ese usually resolve with
re-treatment and intracanal medication. Th e latest
research coming out indicates there is no substitute
for mechanical cleaning, even with the irrigation
magic wands available today. 
Vislisel
Post: 3 of 27
4/19/2023
To be clear, do you mean the apical preparation
size? Would you feel the same way if I had used a
WaveOne Primary, Protaper F2, Next X2, etc.? Th is is
defi nitely one of the things I had considered. 
Townie " Eeznogood " came up with a good list of
reasons for endo failure in the thread I mentioned at
the beginning of this post. I'll provide that below.
1.
Improper diagnosis (missed a fracture).
2. Missed canals.
3.
4.
5.
Inadequate instrumentation.
Inadequate disinfection.
Inadequate posttreatment coronal seal.
6. Posttreatment root fracture.
7. Health issues.
8. My addition: Improper isolation during
treatment.
I'm curious about what you all think is the reason
for this patient having pain on a previously asymptomatic
tooth, how you may have managed the case
diff erently to begin with, and/or how you would
suggest managing it moving forward. 
almunk
Post: 5 of 27
4/19/2023
I've had my share of these after 45 years of doing
endo. All one can do is re-treat it. Two-step this
time. If signs and symptoms get better after the fi rst
visit, then complete the case. If they don't, consider
extraction and implant. 
LouDawg
Post: 4 of 27
4/19/2023
I've had a number of patients (most of them
middle-aged women) who have lingering pain after
root canals or extractions. It's as if it takes a really
long time for the infl ammation to resolve after
treatment. 
JUNE 2023 | 24 | DENTALTOWN.COM

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Dentaltown June 2023

Table of Contents for the Digital Edition of Dentaltown June 2023

Dentaltown June 2023 - Intro
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Dentaltown June 2023 - 1
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