Case 34 Another look required prior to crown?

Pre-operative x-ray #19

Distal canal not negotiated and a mesial lingual canal not negotiated.  Tooth is symptomatic and very tender to percussion.

Immediate post-operative x-ray #19

I was able to negotiate the distal canal and mesial lingual canal to the radiographic apex.  I was not able to fully negotiate the mesial buccal canal.

6 month post-operative check appointment

The tooth is asymptomatic. Almost complete resolution of the apical lesion of the mesial root is noted.

Comments:

Before final cementation of a crown on a tooth that has a "partial" root canal, my best recommendation is that a second opinion is necessary on a questionable root canal.  Too many patients are upset when I have to penetrate a new crown to "complete" a root canal that is only partially done and they were not aware.  I must admit, I don't know what a patient has been told, only what they tell me.  If questions occur and the patient is irritated, I will always call whomever placed the final crown to see if they have told the patient about the possibility of any future problems, i.e. is there something written in the patient's chart notes? As always, communication between providers is key.

Case 33 MTA obturation

Pre-operative x-ray #8

Immediate Post-operative x-ray #8

Symptomatic # 8 which has been apically resorped.

Obturation with MTA entirely.

4 month check x-ray #8

3 year check x-ray #8

After 4 months, asymptomatic with marked apical healing.

After 3 years, asymptomatic with apical radiolucency entirely resolved.

Comments:

In my clinical experience with the use of MTA, which I admit is extremely hard to handle, obturation of canals where the root structure has had resorption, results seem to be very positive. I fill the entire canal system with MTA, never using gutta percha.