Portfolio of Endodontics Cases By: Sahil Arora Class of 2014

Pt M-67  Pt. Presents for class 4 anterior filling on #23. Large lesion leads to carious pulp exposure.  Pt. returns 6 months later with complaints of pain when eating #23  Pain on palpation, percussion, no response to ice testing, normal perio probings  Pulpal Diagnosis: Pulp Necrosis  Periapical Diagnosis: Acute Apical Periodontitis  Visits: 2

Reflection  Procedure was very straightforward  No complications  It was decided to not crown the tooth. Anterior composite would be sufficient.

Pt F-64  Pt. Presents to emergency with pain on previously crowned tooth #31 when chewing food.  Lingering pain to ice test, pain on percussion & palpation  Pulpal Diagnosis: Irreversible Pulpitis Periapical diagnosis: acute apical periodontitis  Visits: 3 (including emergency visit)

Reflection  We thought this was a unique one-canalled first molar, until Dr. Gluskin informed us that one-canalled first molars do not exist, and this is likely to be a second molar moved up (#31)

Pt M-45  Pt presented with lingering pain to cold drinks on tooth #13  Severe lingering pain to cold test for 10 seconds. Responds to palpation and percussion. Normal probing readings.  Pulpal Diagnosis: Irreversible Pulpitis Periapical Diagnosis: Acute apical periodontisis  Visits: 3

Reflection  Canal filed to a 35 per Dr. Fathi’s recommendation  Very straightforward case  No complications arose  Patient was brought in at a later time for buildup/prep/temp

Pt M-74  Pt. Presented to ER with constant pain on #11  Findings included lingering pain to ice test, minor palpative pain, minor percussive pain  Pulpal Diagnosis: Irreversible pulpitis Periapical Diagnosis: Normal  Visits: 3 (Including ER)

Reflection  #11 was apart of a 6-unit bridge spanning canine to canine  Initially, it was thought to simply access through crown, but due to large decay, we chose to remove crown and all the decay with it  Patient had uncontrollable bleeding near apex when obturating, so canal was filled 1mm short of working length to prevent this

F-43  Patient presented to clinic with periapical lesion presented at apex of #11  Findings saw minor pain on percussion and palpation, negative thermal testing and normal probing depths  Pulpal diagnosis: Pulp Necrosis  Periapical diagnosis: chronic apical periodontisis  Visits: 2

Reflection  Very straightforward case  No complications arose  Lingual composite used as a final restoration

F-46  Patient presented with pain on tooth #3. Tooth was previously filled 3 months prior, and base was placed due to proximity to the pulp  Due to consistent pain present after deep filling, Dr. Brown suggested endo therapy  Pulpal Diagnosis: Irreversible Pulpitis Periapical diagnosis: Normal  Visits: 6

Reflections  3 canals found initially, and MB-2 found at a alter time  Mb1 was opened to a size 40 after obturation was seen to be difficult at initial length

Pt F - 47  Special needs patient  Sister brought her in for an emergency visit, due to abscess located above tooth #13  Pulpal Diagnosis: Necrosis Periapical diagnosis: chronic apical periodontitis  Visits: 3

Reflection  Minor difficulty conversing with special needs patient, which slowed the procedure down slightly  It was difficult to secure appropriate radiographs with the rubber dam in place with this patient, leading to a misleading master cone radiograph  Due to this, gutta percha was placed 2- 3mm in excess of the apex.

Pt  Pt presents with lesion in root canal treated #19  RCT retreatment needed due to missed MB2 canal  Patient presented with no symptoms or swellings.  Visits: 4

Reflection  Post/core placed, and original crown preserved