Dentaltown September 2022 - 24

Day Man
You did a good job. Maybe could've gotten closer to the apex, but overall well done. Patient
will survive-give her antibiotics and a specialist can re-treat if necessary. It's just a tooth; relax
a bit and know that you'll mess up much worse than this throughout your career. ■
1/6/2022
BorukhDental
For the palatal canal, what was the largest fi le size you used when you instrumented?
When a patient complains of heat sensitivity after endo, it usually means some tissue was left
behind. It looks like you may have left some tissue either in the palatal canal or MB canals. This
is assuming the symptoms are not coming from another tooth. ■
1/7/2022
It will really be very tough to tell until you see the patient and take some X-rays to confi rm.
If I had to comment on your endo, if you look at the second X-ray carefully, you notice that the
palatal canal and DB areas seem to show obturation that is " hairy " -not dense enough, as if there
are voids. This can happen sometimes when the canal is very large; it can end up underworked and
the obturation can end up a little too narrow relative to the space available. I have done that error
and unfortunately it does lead to endo failure-either because there is still a big chunk of tissue in
the canals that are underworked or because there are large voids that are full of bacteria.
It is not the end of the world if it turns out to be the case. Simply re-treat the tooth, which
shouldn't be too tough. It happens to all of us and it will happen to you again, no matter how
careful you are.
Please stop stressing about it. Calm down. It is not a
big deal. Speak calmly to the patient, offer her a re-treat,
get it done with a smile, and wish her well.
If you need to re-treat, unroof the chamber more
to see better. You can tell you've left a good part of the
chamber not unroofed to the distal, and it looks unfi lled.
Also, very often these
cases with a super wide
chamber can hide a second DB canal. So take a short
moment to look for that. If you have a CBCT, this case
is screaming for one. It will help you detect any missed
extra anatomy. ■
1/7/2022
I'm going to call her and ask
harvestrain
Member Since: 03/27/13
Post: 10 of 67
her to fl oss. The fi nal size of all
canals was F1 of ProTaper series.
I usually run each rotary fi le couple of times and irrigate
and recapitulate after. I am confused as to why a necrotic
pulp can suddenly turn heat-sensitive. The only thing I
can think of was it was partly necrotic, partly not. ■
1/7/2022
Heat sensitivity can happen
eeznogood
Member Since: 02/23/06
Post: 11 of 67
if there are gases in the tooth.
The pain comes from the pressure
felt apically. This is one possibility. I would suggest
you at least see the patient. Take some X-rays, assess the
other teeth and make sure no treatment is needed. ■
1/7/2022
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Dentaltown September 2022

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