Case 44 Incomplete root canal under crown

Pre-operative x-ray #19

A root canal had been attempted some time in the past, evidenced of some type of material in pulp chamber. It seems the canals were not located or negotiated. The patient was unaware of any attempt of a root canal on that tooth. The crown did not have an access opening through it.  Therefore, the crown was placed after root canal was attempted.  Patient was not aware of dates of treatment for this tooth.

Immediate post – operative x-ray #19

As you can surmise from the x-ray, I had an extremely difficult time locating the canal system.

1 year post-operative x-ray #19

Patient is asymptomatic with apical lesions continuing to heal.

Comments:

I would not recommend putting full coverage on a tooth where root canal treatment was not completed, regardless if the tooth is asymptotic at the time. At the very least a consultation is necessary.

Please note: A pulpotomy was done on tooth #18, but patient did not want to pursue treatment at this time because it was asymptomatic. Patient was informed, if this tooth was to have full coverage, a root canal would have to be performed first.

Case 45 Retreatment & teeth treated “overseas”

Pre-operative x-ray #18

Three teeth treated overseas with a paste root canal filling material. The only tooth that was symptomatic was #18, with untreated mesial canals.

Post –operative x-ray #18

Retreat distal canal and treated both mesial canals.

 Please note: The obturated channel between the mesial-buccal and mesial-lingual canals.

Comment:
I see in my practice, many teeth done overseas that have paste root canal fillings which are asymptomatic. I would not treat a tooth with paste fill which is asymptomatic, even if is obvious short-fill, unless the crown is going to be placed /replaced or if an apical lesion is present.  In this particular case #19 & #20 should be left alone.

Case 46 Apical Healing?

Pre-operative x-ray #4

Sypmptomatic tooth #4 with periapical lesion.

Immediate post-operative x-ray #4

Obturation was complete with sealer through the apex.

6 month post-operative x-ray #4

Tooth is asymptomatic healing is almost complete.

Comments:
Apical healing may not occur completely as far as the radiograph is concerned. If the patient was symptomatic to start with, but is now asymptomatic, sometimes this is the best we can hope for. However, it also may take some time for complete healing. i. e. for the apex to completely restore.