Table of Contents
Cover
Title Page
Copyright
Contributors
Acknowledgements
Chapter 1: Introduction
Composition of each Chapter (Chapters 2 to 25)
Benefits of this book
References
Chapter 2: Diagnostic Case I: Tooth Fracture: Unrestorable
Chief Complaint
Medical History
Dental History
Clinical Evaluation (Diagnostic Procedures)
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Post-Treatment Evaluation
References
Chapter 3: Diagnostic Case II:: Exploratory Surgery: Repairing Incomplete Fracture
Chief Complaint
Medical History
Dental History
Clinical Evaluation: (Diagnostic Procedures)
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Histopathologic Diagnosis
Post-Treatment Evaluations
References
Chapter 4: Emergency Case I: Interprofessional Collaboration between Medical and Dental
Chief Complaint
Medical History
Dental History
Clinical Evaluation (Diagnostic Procedures)
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Post-Treatment Evaluation
References
Chapter 5: Emergency Case II: Pulpal Debridement, Incision and Drainage (Intra-oral)
Chief Complaint
Medical History
Dental History
Clinical Evaluation
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Post-Treatment Evaluations
References
Chapter 6: Emergency Case III: Pulpal Debridement, Incision and Drainage (Extra-oral)
Chief Complaint
Medical History
Dental History
Clinical Evaluation
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Post-Treatment Evaluations
References
Chapter 7: Non-surgical Root Canal Treatment Case I: Maxillary Anterior
Chief Complaint
Medical History
Dental History
Clinical Evaluation (Diagnostic Procedures)
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Post-Treatment Evaluations
References
Chapter 8: Non-surgical Root Canal Treatment Case II: Mandibular Anterior
Chief Complaint
Medical History
Dental History
Clinical Evaluation (Diagnostic Procedures)
Pre-Treatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Post-Treatment Evaluation
References
Chapter 9: Non-surgical Root Canal Treatment Case III: Maxillary Anterior/Difficult case (Calcified Coronal ½ Canal System)
Chief Complaint
Medical History
Dental History
Clinical Evaluation (Diagnostic Procedures)
Radiographic Findings
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Post-Treatment Evaluation
References
Chapter 10: Non-surgical Root Canal Treatment Case IV: Maxillary Premolar
Chief Complaint
Medical History
Dental History
Clinical Evaluation (Diagnostic Procedures)
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Post-Treatment Evaluation
References
Chapter 11: Non-surgical Root Canal Treatment Case V: Mandibular Premolar
Chief Complaint
Medical History
Dental History
Clinical Evaluation (Diagnostic Procedures)
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Post-Treatment Evaluation
References
Chapter 12: Non-surgical Root Canal Treatment Case VI: Mandibular Premolar / Difficult Anatomy (three canals)
Chief Complaint
Medical History
Dental History
Clinical Examination (Diagnostic Procedures)
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Post-Treatment Evaluation
References
Chapter 13: Non-surgical Root Canal Treatment Case VII: Maxillary Molar/Four Canals (MB1, MB2, DB, P)
Chief Complaint
Medical History
Dental History
Clinical Evaluation (Diagnostic Procedures)
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Postoperative Evaluation
References
Chapter 14: Non-surgical Root Canal Treatment Case VIII: Mandibular Molar
Chief Complaint
Medical History
Dental History
Clinical Evaluation (Diagnostic Procedures)
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Postoperative Evaluation
References
Chapter 15: Non-surgical Root Canal Treatment Case IX: Maxillary Molar / Difficult Anatomy (Dilacerated Molar Case Management)
Chief Complaint
Medical History
Dental History
Clinical Evaluation (Diagnostic Procedures)
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Postoperative Evaluation
References
Chapter 16: Non-Surgical Re-treatment Case I: Maxillary Anterior
Chief Complaint
Medical History
Dental History
Clinical Evaluation (Diagnostic Procedures)
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Postoperative Evaluation
References
Chapter 17: Non-surgical Re-treatment Case II: Maxillary Premolar
Chief Complaint
Medical History
Dental History
Clinical Evaluation (Diagnostic Procedures)
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Postoperative Evaluation
Addendum
Answers to Self-StudyQuestions
References
Chapter 18: Non-surgical Re-treatment Case III: Mandibular Molar
Chief Complaint
Medical History
Dental History
Clinical Evaluation: Diagnostic Procedures
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Post-Treatment Evaluation
References
Chapter 19: Periapical Surgery Case I: Maxillary Premolar
Chief Complaint
Medical History
Dental History
Clinical Evaluation (Diagnostic Procedures)
Pretreatment Diagnosis:
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Post-Treatment Evaluation
References
Chapter 20: Periapical Surgery Case II: Apical Infection Spreading to Adjacent Teeth
Chief Complaint
Medical History
Dental History
Clinical Evaluation (Diagnostic Procedures)
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Post-Treatment Evaluation
References
Chapter 21: Periapical Surgery Case III: Maxillary Molar
Chief Complaint
Medical History
Dental History
Clinical Evaluation (Diagnostic Procedures)
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Post-Treatment Evaluation
References
Chapter 22: Perio–Endo Interrelationships
Chief Complaint
Medical History
Dental History
Clinical Evaluation (Diagnostic Procedures)
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Post-Treatment Evaluation
References
Chapter 23: Traumatic Injuries:: Avulsed and Root-Fractured Maxillary Central Incisor
Chief Complaint
Medical History
Dental History
Clinical Evaluation (Diagnostic Procedures)
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Post-Treatment Evaluation
References
Chapter 24: Incompletely Developed Apices
Chief Complaint
Medical History
Dental History
Clinical Evaluation (Diagnostic Procedures)
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Post-Treatment Evaluation
References
Chapter 25: External/Internal Resorption
Chief Complaint
Medical History
Dental History
Clinical Evaluation (Diagnostic Procedures)
Pretreatment Diagnosis
Treatment Plan
Prognosis
Clinical Procedures: Treatment Record
Postoperative Evaluation
References
INDEX for Clinical Cases in Endodontics
End User License Agreement
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Guide
Cover
Table of Contents
Begin Reading
List of Illustrations
Chapter 1: Introduction
Figure 1.1 Tooth designation: three system summary.
Figure 1.2 Pulpal and apical diagnostic terminology.
Chapter 2: Diagnostic Case I: Tooth Fracture: Unrestorable
Figure 2.1 The initial radiograph of tooth #31. Notice the shallow restoration and the periapical rarefaction at the root apices.
Figure 2.2 The extent of rarefaction in the distal root of tooth #31. Note how the radiolucency moves up to the alveolar crest.
Figure 2.3 Mesial to distal crack of tooth #31, stained with methylene blue to better visualize the extent of the crack.
Figure 2.4 Fiber optic light illumination of tooth #31 shows that the crack goes below the CEJ. The light does not pass through from lingual to buccal.
Figure 2.5 Fiber optic light was used on the buccal surface to confirm the crack.
Figure 2.6 Diagnosis of a split tooth is confirmed after the extraction of tooth #31.
Chapter 3: Diagnostic Case II:: Exploratory Surgery: Repairing Incomplete Fracture
Figure 3.1 Radiograph taken by patient's general dentist 4 months prior to the Pt coming to the office. Tooth #7 had been endodontically treated with silver point.
Figure 3.2 Tooth #7 was retreated and the root canal obturation looks adequate.
Figure 3.3 Sinus tract was seen in the apical area between teeth #7 and #8.
Figure 3.4 Preoperative radiograph shows teeth #7 and #8 have normal apex.
Figure 3.5 Gutta percha traces sinus tract.
Figure 3.6 Gutta-percha tracing radiograph shows a 2 mm × 4 mm lateral lesion on tooth #8, with the distal surface extending from 2 mm coronal of the radiographic apex to 6 mm below the alveolar crest.
Figure 3.7 A crack line was observed in the root of tooth #8.
Figure 3.8 The crack line was repaired.
Figure 3.9 Working-length radiograph of tooth #8. Root canal treatment was initiated due to the possibility of devitalizing pulp by the crack-line repairing procedure.
Figure 3.10 Obturation radiograph of tooth #8.
Figure 3.11 Histologic slides of the biopsy tissue revealed a cyst lined by hyperplastic unkeratinized stratified squamous epithelium. The wall contains mild to moderate inflammatory reaction. A: Original magnification ×4; B: Original magnification ×40.
Figure 3.12 One-year follow-up radiograph reveals healing of the lateral lesion on the distal side of tooth #8.
Figure 3.13 Three-year follow-up clinical photograph. Gingiva looks normal.
Figure 3.14 Three-year follow-up clinical photograph. No bleeding upon probing.
Figure 3.15 Three-year follow-up radiograph shows normal apex of teeth #7 and #8 and healing of the lateral lesion on the distal side of tooth #8.
Chapter 4: Emergency Case I: Interprofessional Collaboration between Medical and Dental
Figure 4.1 Preoperative photograph, before drainage procedure by an otolaryngologist.
Figure 4.2 Preoperative photograph during the emergency appointment.
Figure 4.3 Postoperative photograph, after drainage procedure on the sinus tract by an otolaryngologist.
Figure 4.4 Preoperative radiograph.
Figure 4.5 Postoperative radiograph after the initial emergency treatment (pulp debridement and placement of calcium hydroxide).
Figure 4.6 Preoperative radiograph for the second visit after 13 days of calcium hydroxide treatment. Patient was asymptomatic at this appointment.
Figure 4.7 Master cone radiograph with gutta percha.
Figure 4.8 Final radiograph with gutta percha and amalgam core build-up.
Figure 4.9 Six-month recall photograph.
Figure 4.10 Six-month recall radiograph.
Chapter 5: Emergency Case II: Pulpal Debridement, Incision and Drainage (Intra-oral)
Figure 5.1 Pt presents with extra-oral swelling on LL quadrant and facial asymmetry.
Figure 5.2 Extra-oral swelling on LL with asymmetry.
Figure 5.3 Intra-oral swelling on buccal area of tooth #19. Gingival tissues are erythematous.
Figure 5.4 Preoperative radiograph of tooth #19. Tooth #19 presents with PFM crown, large PAR on M root and smaller PAR on D root. MB and ML canals appear calcified.
Figure 5.5 Purulent discharge noted upon accessing pulpal chamber. RDI in place with tooth #14. RD clamp and OraSeal® on B and L surfaces.
Figure 5.6 Hemorrhage noted after initial C&S, under RDI.
Figure 5.7 Ca(OH)2 placement verification. Extrusion noted on M root. D canal appears filled to mid-root level.
Figure 5.8 I&D performed on buccal gingiva. Hemorrhage and purulent discharge noted.
Figure 5.9 Master cone fit radiograph of tooth #19.
Figure 5.10 Postoperative radiograph of tooth #19, with sealer puff on M root.
Chapter 6: Emergency Case III: Pulpal Debridement, Incision and Drainage (Extra-oral)
Figure 6.1 Submandibular swelling of LRQ and associated facial asymmetry.
Figure 6.2 Skin is red with a shiny spot at the point of highest fluctuance.
Figure 6.3 Preoperative periapical radiograph of tooth #31.
Figure 6.4 Preoperative periapical radiograph of tooth #31.
Figure 6.5 Preoperative bitewing radiograph of tooth #31.
Figure 6.6 I&D performed, abundant purulent discharge produced. Area and patient isolated with standard draping.
Figure 6.7 Two weeks after emergency I&D, patient returned asymptomatic. Skin does not appear red. No swelling noted. Small linear scar present at site of I&D.
Figure 6.8 Master cone radiograph of tooth #31.
Figure 6.9 Postoperative radiograph of tooth #31.
Chapter 7: Non-surgical Root Canal Treatment Case I: Maxillary Anterior
Figure 7.1 Preoperative radiograph of tooth #10.
Figure 7.2 Master cone radiograph of tooth #10.
Figure 7.3 Post-treatment radiograph of tooth #10.
Figure 7.4 One-year post-treatment radiograph of tooth #10.
Figure 7.5 Nasopalatine foramen can be mistaken for an endodontic lesion.
Figure 7.6 Cold testing using a cotton pellet saturated with ice refrigerant.
Figure 7.7 Digital palpation of apical mucosa.
Figure 7.8 Percussion test using a mirror handle.
Figure 7.9 Paralleling technique for anterior periapical radiograph.
Figure 7.10 Different angulations for anterior periapical radiograph.
Figure 7.11 A radiograph of maxillary lateral incisor with two canals.
Figure 7.12 CBCT of maxillary right lateral incisor. The image on the upper left is a coronal view of an endodontically treated tooth #7. One can see a break in the buccal plate due to the resorptive defect. The image on the upper right is a 3-D creation of the maxilla. The images on lower right and lower left are sagittal and axial views of tooth #7, respectively. These views give the clinician information on the dimensions and extent of the lesion.
Chapter 8: Non-surgical Root Canal Treatment Case II: Mandibular Anterior
Figure 8.1 Preoperative buccal swelling with sinus tract between teeth #25 and 26.
Figure 8.2 Preoperative radiograph of teeth #23–27. Note the slight mesial displacement of the apex of tooth #25 and bone loss along the distal root surface. (Radiograph courtesy of Dr. Domenico Ricucci).
Figure 8.3 Access opening tooth #25 after obturation completed. The preparation has been extended half-way through the incisal edge to improve access to the large canal space in a young patient. The mesio-distal preparation is conservative to reflect the external and internal anatomy. (Photograph courtesy of Dr. Domenico Ricucci).
Figure 8.4 Working-length determination. (Radiograph courtesy of Dr. Domenico Ricucci).
Figure 8.5 Postoperative radiograph of tooth #25. Oburation of the canal space includes fill of large lateral canal on the distal surface. (Radiograph courtesy of Dr. Domenico Ricucci).
Figure 8.6 Postoperative angled radiograph to visualize complete obturation of the buccal and lingual canals. (Radiograph courtesy of Dr. Domenico Ricucci).
Figure 8.7 Thirteen-year follow-up. There is complete healing of the preoperative radiolucency and resorption of the extruded sealer on the distal surface of the root. (Radiograph courtesy of Dr. Domenico Ricucci).
Figure 8.8 Fourteen-year follow-up. (Radiograph courtesy of Dr. Domenico Ricucci).
Figure 8.9 Angled working-length radiograph to aid in visualization of the second canal. (Radiograph courtesy of Dr. Domenico Ricucci).
Figure 8.10 Micro-CT images of three different teeth to show the varying anatomic patterns: A: Vertucci type I with round canal, B: Vertucci type I with oval canal, C: Vertucci type III. Cross section images labeled as: c = cervical, m = middle, a = apical. (Image adapted from Paes da Silva Ramos Fernandes et al. (2014)).
Figure 8.11 Access outline for A: the mandibular central and lateral incisors and B: the mandibular canine. (Illustration by Mr. Oran Suta.)
Figure 8.12 Lateral view of mandibular incisor showing A: Initial penetration with round bur until the pulp chamber is reached, B: Extension of the access prep towards the incisal edge and the cingulum areas in order to aid in straight line access and discovery of the lingual canal. (Illustration by Mr. Oran Suta.)
Chapter 9: Non-surgical Root Canal Treatment Case III: Maxillary Anterior/Difficult case (Calcified Coronal ½ Canal System)
Figure 9.1 Preoperative radiograph: First visit (Day 1).
Figure 9.2 Preoperative radiograph: Second visit (2 years, Day 1).
Figure 9.3 Axial CBCT slice mid-root through canal tooth #11.
Figure 9.4 Frontal CBCT slice of tooth #11.
Figure 9.5 Sagittal CBCT slice of tooth #11.
Figure 9.6 Clinical photograph showing discoloration of tooth #11 due to internal calcification.
Figure 9.7 Clinical photograph showing tooth #11 after completion of internal bleaching.
Figure 9.8 Clinical photograph showing comparison pre- and post-internal bleaching of tooth #11. (Top: pre-internal bleaching, Bottom: post-internal bleaching)
Figure 9.9 Postoperative radiograph of completed endodontic therapy of tooth #11.
Figure 9.10 One-year recall radiograph emailed from a referring dentist.
Figure 9.11 Four-year recall radiograph, tooth #11.
Figure 9.12 Four-year recall clinical photograph, tooth #11.
Chapter 10: Non-surgical Root Canal Treatment Case IV: Maxillary Premolar
Figure 10.1 Initial radiograph. Tooth #5 showed the presence of a mesio-occlusal-distal (MOD) amalgam restoration. No carious lesions are observed under the restoration. Widened apical periodontal ligament is observed.
Figure 10.2 Radiographic evaluation of the obturation. Immediately after the injection and compaction of warm gutta-percha, a periapical radiograph was taken to confirm the obturation of the case. Some sealer extruded from the root canal can be observed in the apical region.
Figure 10.3 Final radiograph. Complete obturation is observed. Coronally, one can observe the space where the sterile cotton pellet was placed and the temporary restoration.
Figure 10.4 Twenty-nine-month follow-up. Tooth #5 showed a positive prognosis after the root canal treatment. The restoration was well-adapted and the extruded sealer had resorbed.
Figure 10.5 Sixty-three-month follow-up. Tooth #5 did not show any sign of pathological process related to the root canal treatment. The tooth is still asymptomatic, with normal occlusal function.
Chapter 11: Non-surgical Root Canal Treatment Case V: Mandibular Premolar
Figure 11.1 Preoperative clinical photograph of tooth #29.
Figure 11.2 Preoperative periapical radiograph of tooth #29.
Figure 11.3 Preoperative panoramic radiograph showing mandibular right premolar and molar regions.
Figure 11.4 Preoperative multi-slice CT images of tooth #29. Coronal view (A) and sagittal view (B). The B cortical plate of the apical region of the tooth #29 is interrupted, and the PARL involving tooth #29 shows communication with the mandibular canal.
Figure 11.5 Two months after root canal filling of tooth #29.
Figure 11.6 Fifteen-month follow-up of tooth #29. Periapical (A) and panoramic (B) radiographs. Tooth #29 shows a complete resolution of PARL.
Figure 11.7 The case of tooth #20. (Not the case presented in this chapter; Courtesy Dr. Sonoko Noda, Tokyo Medical and Dental University) A: Preoperative periapical radiograph. B: Intraoperative CBCT (3DX, J. Morita, Kyoto, Japan). C: Microscopic view of canal orifices, showing the presence of three orifices. Arrow shows the orifice of the middle canal. D: Schematic drawing of C. E: Three months after root canal filling.
Figure 11.8 The case of tooth #20 (not the case presented in this chapter) showing a radiolucent area corresponding to the mental foramen around its apex.
Chapter 12: Non-surgical Root Canal Treatment Case VI: Mandibular Premolar / Difficult Anatomy (three canals)
Figure 12.1 Preoperative radiographs of tooth #21, showing Class 5 restoration and wide root tri-furcating at coronal-middle third of root. A: Straight view; B: Mesial angled view.
Figure 12.2 Down-packed and backfilled DB and L canals and checking the MB canal.
Figure 12.3 Checking the MB canal.
Figure 12.4 The MB canal obturated.
Figure 12.5 A: Postobturation radiograph showing three canals with three different exit portals; B: Postobturation radiograph showing three exit portals.
Chapter 13: Non-surgical Root Canal Treatment Case VII: Maxillary Molar/Four Canals (MB1, MB2, DB, P)
Figure 13.1 Preoperative radiograph, first visit (Day 1).
Figure 13.2 MB1 and DB length-estimation radiograph (Day 1).
Figure 13.3 MB2 and P length-estimation radiograph (Day 1).
Figure 13.4 Postoperative radiograph, second visit (Day 14).
Figure 13.5 One-year follow-up radiograph showing healed lesion.
Figure 13.6 Intra-oral picture showing location of MB2 (Day 14).
Figure 13.7 Maxillary 1st molar tooth #3 showing presence of MB2.
Figure 13.8 Maxillary 2nd molar tooth #15 showing presence of MB2.
Figure 13.9 Maxillary 1st molar tooth #3 showing presence of MB2.
Figure 13.10 Maxillary 1st molar tooth #14 showing presence of MB2.
Figure 13.11 Maxillary 2nd molar tooth #2 showing presence of MB2.
Figure 13.12 Unusual Maxillary 1st molar, tooth #3, showing presence of MB1, MB2 and MB3.
Figure 13.13 Maxillary molar tooth #14 with the second palatal canal and MB2.
Chapter 14: Non-surgical Root Canal Treatment Case VIII: Mandibular Molar
Figure 14.1 Preoperative images showing a 1 cm erythematous and crusted-surface nodule (A) and the offending tooth with no intraoral swelling (B).
Figure 14.2 Preoperative images showing periapical (Orthoradial (A), mesial (B), and distal (C) angulations) and bitewing (D) radiographs.
Figure 14.3 Periapical radiographs taken for working-length determination (A), master cone fit (B), and obturation (C).
Figure 14.4 Extraoral image showing the sinus tract was healed with slight dimpling.
Figure 14.5 Recall radiographs after 3 months (A), 8 months (B), 12 months (C), and 14 months (D) intervals.
Chapter 15: Non-surgical Root Canal Treatment Case IX: Maxillary Molar / Difficult Anatomy (Dilacerated Molar Case Management)
Figure 15.1 Preoperative radiograph.
Figure 15.2 Master cone gutta-percha fit radiograph.
Figure 15.3 Final fill radiograph 1.
Figure 15.4 Final fill radiograph 2.
Figure 15.5 One-year recall radiograph 1.
Figure 15.6 One-year recall radiograph 2.
Chapter 16: Non-Surgical Re-treatment Case I: Maxillary Anterior
Figure 16.1 Intraoral photograph with draining sinus tract (red arrow) and a fibrous tissue (blue arrow).
Figure 16.2 Pretreatment radiographs with gutta-percha point positioned in the sinus tract, pointing toward the tooth #7. A: Periapical radiograph. B: Axial occlusal radiograph.
Figure 16.3 Post-treatment radiograph.
Figure 16.4 Three-month recall radiograph.
Figure 16.5 Six-month recall radiographs. A: Periapical radiograph. B: Axial occlusal radiograph.
Chapter 17: Non-surgical Re-treatment Case II: Maxillary Premolar
Figure 17.1 Intraoral photograph. Note: Root canal treatment has already been initiated as retreatment in teeth #3 and #4. In each tooth, access is sealed with CavitTM temporary filling material.
Figure 17.2 Periapical radiograph taken at initial visit.
Figure 17.3 Periapical radiograph showing completed obturation of teeth #3 and #4.
Figure 17.4 Intraoral photograph taken immediately after root canal obturation.
Figure 17.5 Periapical radiograph taken 6 months after root canal treatment.
Figure 17.6 Periapical radiograph taken 12 months after root canal treatment.
Chapter 18: Non-surgical Re-treatment Case III: Mandibular Molar
Figure 18.1 Preoperative 2-D radiograph showing hint of periapical radiolucency mesial root of tooth #31.
Figure 18.2 Comparison of preoperative 2-D radiograph and 3-D CBCT image showing the enhanced clarity of the periapical in 3-D CBCT imaging.
Figure 18.3 Clinical photograph taken with dental operating microscope. View showing contaminated ML canal which was previously untreated. The gutta-percha in MB canal is contiguous with ML canal space. The distal part of the composite core build up with post was intact without leakage. Slight recurrent caries shown at the amalgam restoration at the mesial area.
Figure 18.4 The juxtaposition of 3-D CBCT diagnostic imaging and the view through the dental operating microscope (×5.1) correlates the diagnostic imaging with operating field inside the pulp chamber.
Figure 18.5 Clinical photograph taken with dental operating microscope view after instrumentation and disinfection of ML and MB canals. The gutta-percha in MB canal had been removed.
Figure 18.6 Working radiograph measuring the length of the canal.
Figure 18.7 Working radiograph monitoring the obturation process.
Figure 18.8 Final radiograph taken after obturation of root canal space and restoration of endodontic access.
Figure 18.9 One-year follow-up 2-D radiograph indicating complete resolution of the periapical lesion.
Figure 18.10 Comparison of 3-D CBCT images taken preoperatively (top) and at 1-year follow-up (bottom) showing complete osseous healing of the periapical lesion.
Chapter 19: Periapical Surgery Case I: Maxillary Premolar
Figure 19.1 Preoperative photograph of tooth #12.
Figure 19.3 Root end inspection and visualization of obturation material with dental operating microscope (DOM)
Figure 19.4 Surgical inspection with dental operating microscope (DOM).
Figure 19.5 Ultrasonic instrumentation (KiS 3 tip, Spartan/ObturaTM) in parallel to long axis of root surface and into canal.
Figure 19.6 Root end sealed with MTA.
Figure 19.7 Postoperative radiograph of tooth #12 with MTA retrofill.
Figure 19.8 Immediate postsurgical appearance, with sutures.
Figure 19.9 Fourteen-day postoperative check.
Chapter 20: Periapical Surgery Case II: Apical Infection Spreading to Adjacent Teeth
Figure 20.1 Radiograph after root canal filling of tooth #24. (With permission from Komabayashi, T., Jiang, J., Zhu, Q. (2011) Apical infection spreading to adjacent teeth: a case report. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 111 (6), e15–20.)
Figure 20.2 Radiograph 4 months after root canal filling of tooth #24. (With permission from Komabayashi, T., Jiang, J., Zhu, Q. (2011) Apical infection spreading to adjacent teeth: a case report. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 111 (6), e15–20.)
Figure 20.3 Radiograph after root canal filling of teeth #23 and 25. (With permission from Komabayashi, T., Jiang, J., Zhu, Q. (2011) Apical infection spreading to adjacent teeth: a case report. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 111 (6), e15–20.)
Figure 20.4 Root-end surgery on teeth # 23, 24, and 25. A: Purulent exudate was seen as the flap was being reflected near the apical area of teeth #23, 24, and 25. B: Inflamed periosteum. C: Periradicular lesion. D: Removed tissue attached to the apex of tooth #24 for biopsy. E: Root-end preparation. F: Root-end filling with white MTA. G: Bio-Oss was placed into the bony crypt. H: Bio-Gide membrane was placed. (With permission from Komabayashi, T., Jiang, J., Zhu, Q. (2011) Apical infection spreading to adjacent teeth: a case report. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 111 (6), e15–20.)
Figure 20.5 A: Radiograph immediately after root-end filling with MTA. B: Six-month follow-up. C: One-year follow-up. D: Two-year follow-up. (With permission from Komabayashi, T., Jiang, J., Zhu, Q. (2011) Apical infection spreading to adjacent teeth: a case report. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 111 (6), e15–20.)
Figure 20.6 Histologic slides of the biopsy tissue revealed a cyst lined by non-keratinized stratified squamous epithelium. The wall contains mild to moderate inflammatory response. A: Original magnification ×10. B: Original magnification ×40. (With permission from Komabayashi, T., Jiang, J., Zhu, Q. (2011) Apical infection spreading to adjacent teeth: a case report. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology 111 (6), e15–20.)
Chapter 21: Periapical Surgery Case III: Maxillary Molar
Figure 21.1 Preoperative radiographs of tooth #14 (A and B).
Figure 21.2 Periapical radiograph after completion of apicoectomy on buccal roots of tooth #14.
Figure 21.3 Five-week postoperative radiograph of tooth #14.
Figure 21.4 Twenty-five-month postoperative radiographs (A and B). Periapical healing is shown on buccal roots of tooth #14.
Figure 21.5 Presence of silver cones on tooth #3 with periapical radiolucency associated with MB root.
Figure 21.6 Radiograph showing a fiber post placed in MB root with the presence of apical radiolucency on tooth #14. Apicoectomy is preferred on this case over non-surgical re-treatment.
Figure 21.7 CBCT images of tooth #3 with root canal treated palatal root and non-negotiable buccal roots. A: The sagittal image shows the overall extension of maxillary sinus in relation to maxillary 2nd premolar, 1st and 2nd molars. This slice also shows two calcified buccal roots of tooth #3. The coronal slice (B) aids in examining the presence or absence of the maxillary sinus between roots before surgical endodontic re-treatment on tooth #3. In this slice, the interradicular extension of the maxillary sinus in between the buccal and palatal roots is evident. The red line on sagittal (A) image shows where the axial plain shown in (C) was obtained. The axial view also shows the proximity of buccal roots to the maxillary sinus (C).
Chapter 22: Perio–Endo Interrelationships
Figure 22.1 Preoperative periapical radiograph of tooth #30.
Figure 22.2 Preoperative bitewing radiograph of tooth #30.
Figure 22.3 Internal resorptive defect was found in the DL aspect of the pulp chamber of tooth #30.
Figure 22.4 Radiograph to measure the working length of tooth #30.
Figure 22.5 Radiograph with the master cones fit of tooth #30.
Figure 22.6 Composite restoration was placed over the resorptive defect of tooth #30.
Figure 22.7 Postoperative radiograph of tooth #30.
Figure 22.8 Postoperative radiograph of tooth #30 from a different angle.
Figure 22.9 One-year follow-up radiograph of tooth #30.
Figure 22.10 Twenty-month follow-up radiograph of tooth #30.
Chapter 23: Traumatic Injuries:: Avulsed and Root-Fractured Maxillary Central Incisor
Figure 23.1 A periapical radiograph showing the retained apical fragment of the root of tooth #8 and the space (red arrow) from which the coronal fragment of the root was avulsed. The retained apical fragment has an open apex.
Figure 23.2 The coronal fragment of the root of tooth #8 was repositioned by the emergency dentist of a hospital and splinted with interproximal composite resin to teeth #7 and #9. The root fragments have been placed in close apposition (red arrow).
Figure 23.3 A clinical photograph of the second splint consisting of composite resin and light wire placed after failure of the interproximal composite resin splint. The remains of the first splint placed earlier that same day are seen between teeth #8 and #9 (red arrow). A 4/0 silk suture was placed between teeth #7 and #8 to unite a gingival laceration.
Figure 23.4 A clinical photograph of the third splint of composite resin and Ribbond® (red arrow) placed after the patient had been referred for specialist management.
Figure 23.5 A periapical radiograph showing good apposition of the fractured root fragments with the third splint (red arrow).
Figure 23.6 A clinical photograph taken 1 month after the initial injury showing the Ribbond® splint distended (red arrow) and tooth #8 extruded below the occlusal plane. There is a gingival swelling adjacent tooth #8.
Figure 23.7 A periapical radiograph taken 1 month after the initial injury showing separation of the two fractured fragments (red arrow). Loss of alveolar bone on the distal aspect of tooth #8 is evident.
Figure 23.8 A periapical radiograph showing the coronal root fragment of tooth #8 root filled with MTA. The access cavity has been restored with glass ionomer cement and composite resin. The root fragments remain separated (red arrow).
Figure 23.9 A periapical radiograph taken 1 year after the injury showing healing by deposition of calcific tissue between the fractured root fragments (red arrow). Intra-canal calcification of the apical fragment is evident. An incidental finding was the PA radiolucency associated with #7 consistent with a diagnosis of asymptomatic apical periodontitis (AAP). This tooth was responsive to cold pulp sensibility testing consistent with a false positive test. The management of this tooth is not discussed in this report.
Figure 23.10 A periapical radiograph taken 10 years after the injury. Healing by hard tissue is likely as no periodontal ligament (PDL) space is evident between the previously fractured root fragments (red arrow). Further calcification of the apical fragment has occurred. Teeth #7 and #9 have been root filled. A favorable healing outcome, as evidenced by osseous repair for all root-filled teeth.
Chapter 24: Incompletely Developed Apices
Figure 24.1 Preoperative periapical radiograph of tooth #31 showing incompletely developed apices.
Figure 24.2 Preoperative bitewing radiograph showing the extensive coronal radiolucency encroaching on the pulp.
Figure 24.3 Preoperative photograph showing intact occlusal surface.
Figure 24.4 Pulp exposure during decay removal.
Figure 24.5 Orthodontic band cemented on with KetacTM cement (rubber dam clamp popped off and building up tooth was necessary in order to reapply clamp).
Figure 24.6 Pulp hemostasis after pulpotomy and decay removal completed.
Figure 24.7 MTA placed in pulp chamber.
Figure 24.8 Postoperative radiograph (taken with sensor vertical).
Figure 24.9 Follow-up 1 year 1 month.
Figure 24.10 Follow-up 1 year 9 months.
Figure 24.11 Follow-up 2 years 3 months.
Figure 24.12 Follow-up 3 years 7 months.
Figure 24.13 Preoperative pulpal bleeding.
Figure 24.14 Sodium hypochlorite-saturated cotton pellet placed over pulp.
Figure 24.15 Pulp still bleeding after 10 minutes of use of sodium hypochlorite saturated cotton pellet.
Figure 24.16 Pulpotomy on a molar.
Figure 24.17 Pulp hemostasis after removing a few more millimeters of pulpal tissue and replacement of sodium hypochlorite pellet for a few minutes.
Figure 24.18 Endosequence® Root Repair Material covering pulp.
Figure 24.19 Glass ionomer placed to cover Endosequence® Root Repair Material (tooth ready to restore).
Figure 24.20 Preoperative radiograph of tooth #9 with open apex (history of avulsion, replanted, and splint).
Figure 24.21 Working-length radiograph.
Figure 24.22 MTA apical barrier of about 5 mm.
Figure 24.23 Canal backfilled with gutta-percha after coating canal with sealer.
Figure 24.24 Access restored with composite resin.
Figure 24.25 Follow-up 6 months.
Figure 24.26 Follow-up 1 year.
Chapter 25: External/Internal Resorption
Figure 25.1 Preoperative radiograph reveals an irregular radiolucency extending both coronally and into the radicular tooth structure on the distal cervical side of tooth #23.
Figure 25.2 The resorption defect was prepared for restoration. CavitTM was placed to protect the canal space.
Figure 25.3 The cervical resorptive defect was restored with composite resin.
Figure 25.4 The flap was repositioned and interrupted sutures with silk were placed.
Figure 25.5 Working-length radiograph measuring the length of the canal.
Figure 25.6 Radiograph was taken after obturation of root canal.
Figure 25.7 Fifteen-month follow-up radiograph shows no sign of periradicular pathosis or recurrence of the resorption.
Figure 25.8 Two-year follow-up radiograph shows no evidence of periapical pathosis or extension of the treated resorptive lesion.
Figure 25.9 Two-year follow-up shows the composite resin restoration was intact with no signs of recurrence of the cervical resorption.
List of Tables
Chapter 8: Non-surgical Root Canal Treatment Case II: Mandibular Anterior
Table 8.1 Root canal anatomy of mandibular incisors.
Chapter 17: Non-surgical Re-treatment Case II: Maxillary Premolar
Table 17.1 Classification and number of root canals (%) in maxillary/mandibular premolars (Vertucci 1984).
Table 17.2 Clinical outcomes for initial premolar treatment and re-treatment.
Chapter 19: Periapical Surgery Case I: Maxillary Premolar
Table 19.1 Comparison between traditional and modern techniques.
Clinical Cases Series
Wiley-Blackwell's Clinical Cases series is designed to recognize the centrality of clinical cases to the dental profession by providing actual cases with an academic backbone. This unique approach supports the new trend in case-based and problem-based learning. Highly illustrated in full color, the Clinical Cases series utilizes a format that fosters independent learning and prepares the reader for case-based examinations.
Clinical Cases in Endodontics
by Takashi Komabayashi (Editor)
Clinical Cases in Orofacial Pain
by Malin Ernberg, Per Alstergren
Clinical Cases in Implant Dentistry
by Nadeem Karimbux (Editor), Hans-Peter Weber (Editor)
Clinical Cases in Orthodontics
by Martyn T. Cobourne, Padhraig S. Fleming, Andrew T. DiBiase, Sofia Ahmad
Clinical Cases in Pediatric Dentistry
by Amr M. Moursi (Editor), Marcio A. da Fonseca (Assistant Editor), Amy L. Truesdale (Associate Editor)
Clinical Cases in Periodontics
by Nadeem Karimbux (Editor)
Clinical Cases in Prosthodontics
by Leila Jahangiri, Marjan Moghadam, Mijin Choi, Michael Ferguson
Clinical Cases in Restorative and Reconstructive Dentistry
by Gregory J. Tarantola
Clinical Cases in Endodontics
Takashi Komabayashi
University of New England
This edition first published 2018
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Library of Congress Cataloging-in-Publication Data
Names: Komabayashi, Takashi, 1973- editor.
Title: Clinical cases in endodontics / edited by Takashi Komabayashi.
Description: Hoboken, NJ : Wiley, 2017. | Series: Clinical cases series | Includes bibliographical references and index. |
Identifiers: LCCN 2017020926 (print) | LCCN 2017021343 (ebook) | ISBN 9781119147114 (pdf) | ISBN 9781119147060 (epub) | ISBN 9781119147046 (pbk.)
Subjects: | MESH: Root Canal Therapy-methods | Endodontics-methods | Case Reports
Classification: LCC RK351 (ebook) | LCC RK351 (print) | NLM WU 230 | DDC 617.6/342-dc23
LC record available at https://lccn.loc.gov/2017020926
Cover Design: Wiley
Cover Images: (Column 1) Courtesy of Howard Foo;(Column 2) Courtesy of Qiang Zhu and Keivan Zoufan;(Column 3) Courtesy of Nathaniel Nicholson
Editor
Takashi Komabayashi , DDS, MDS, PhD, Diplomate, American Board of Endodontics, Clinical Professor, University of New England College of Dental Medicine, Portland, Maine, USA.
Chapter Authors
Jeffrey Albert , DMD, Diplomate, American Board of Endodontics, Private Practice, Endodontic Associates, West Palm Beach, Florida, USA.Abdullah Alqaied ,
Bruce Y. Cha , DMD, FAGD, FACD, FICD, Diplomate, American Board of Endodontics, Private Practice, Endodontic LLC, New Haven and Hamden;
Section Chief, Endodontics, Department of Dentistry, Yale-New Haven Hospital, New Haven;
Assistant Clinical Professor, Yale School of Medicine, New Haven;
Assistant Clinical Professor, Division of Endodontology, School of Dental Medicine, University of Connecticut, Farmington, Connecticut, USA.
Priya S. Chand , BDS, MSD, Diplomate, American Board of Endodontics, Clinical Associate Professor, Division of Endodontics, University of Maryland Dental School, Baltimore, Maryland, USA.Daniel Chavarría-Bolaños , DDS, MSc, PhD, Professor/Researcher, Facultad de Odontología, Universidad de Costa Rica, San José, Costa Rica.Kana Chisaka-Miyara , DDS, PhD, Part-time Lecturer, Department of Pulp Biology and Endodontics, Tokyo Medical and Dental University, Tokyo, Japan.Suanhow Howard Foo , DDS, Diplomate, American Board of Endodontics, Private Practice, Hacienda Heights, California, USA.Denise Foran , DDS, Diplomate, American Board of Endodontics, Program Director/Advanced Specialty Program in Endodontics, Department of Veterans Affairs New York Harbor Healthcare System, New York, USA.Nada Ibrahim , BDS, Saudi Board of Endodontics, University Staff Clinics, College of Dentistry, King Saud University, Riyadh, Saudi Arabia.Ahmed O Jamleh , BDS, MSc., PhD, Assistant Professor of Endodontics, Restorative and Prosthetic Dental Sciences, College of Dentistry, King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Riyadh, Saudi Arabia.
Jin Jiang , DDS, PhD, Diplomate, American Board of Endodontics, Private Practice, Endodontic LLC, New Haven and Hamden;
Assistant Professor, Division of Endodontology, University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA.
Bill Kahler , DClinDent, PhD, School of Dentistry, University of Queensland, Brisbane, Australia.Takashi Komabayashi , DDS, MDS, PhD, Diplomate, American Board of Endodontics, Clinical Professor, University of New England College of Dental Medicine, Portland, Maine, USA.Louis M. Lin , BDS, DMD, PhD, Diplomate, American Board of Endodontics, Professor, Department of Endodontics, New York University College of Dentistry, New York, USA.David Masuoka-Ito , DDS, PhD, Researcher Professor, Department of Somatology, Universidad Autónoma de Aguascalientes, Aguascalientes, México.Katia Mattos , DMD, Diplomate, American Board of Endodontics, Private Practice, Miami, Florida, USA.Nathaniel T. Nicholson , DDS, MS, Diplomate, American Board of Endodontics, Private Practice, Galesville, MD; Clinical Assistant Professor, West Virginia University School of Dentistry, Morgantown, West Virginia, USA.Takashi Okiji , DDS, PhD, Professor, Department of Pulp Biology and Endodontics, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.Pejman Parsa , DDS, MS, Diplomate, American Board of Endodontics, Private Practice, West LA Endodontics, Los Angeles, California, USA.Amaury J. Pozos-Guillén , DDS, MSc, PhD, Professor, Facultad de Estomatología, Universidad Autónoma de San Luis Potosí, San Luis Potosí, SLP, México.Amr Radwan , BDS, Diplomate, American Board of Endodontics, Private Practice, Miami, Florida, USA.Jessica Russo Revand , DMD, MS, Private Practice, Northern Virginia Endodontic Associates, Arlington, Virginia, USA.John M. Russo , DMD, Associate Clinical Professor, Division of Endodontics, University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA.Khaled Seifelnasr , BDS, DDS, MS, Private Practice, Hudson, New Hampshire; Lecturer on Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA.
Andrew L. Shur , DMD, Diplomate, American Board of Endodontics, Private Practice, Endodontic Associates, Portland
,
Assistant Clinical Professor, University of New England College of Dental Medicine, Portland, Maine, USA.
Savita Singh , DDS, Private Practice, New York, USA.Victoria E. Tountas , DDS, Diplomate, American Board of Endodontics, Private Practice, Plano, Texas, USA.
Gayatri Vohra , DDS, Private Practice, Acton and Concord Endodontics
,
Lecturer on Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA.
Andrew Xu , DDS, MS, Diplomate, American Board of Endodontics, Private Practice, Plano, Texas, USA.Yoshio Yahata , DDS, PhD, Assistant Professor, Division of Endodontology, Department of Conservative Dentistry, Showa University School of Dentistry, Tokyo, Japan.Maobin Yang , DMD, MDS, PhD, Diplomate, American Board of Endodontics, Assistant Professor, Department of Endodontology, Kornberg School of Dentistry, Temple University, Philadelphia, Pennsylvania, USA.Parisa Zakizadeh , DDS, MS, Qiang Zhu , DDS, PhD, Diplomate, American Board of Endodontics, Professor, Division of Endodontology, University of Connecticut School of Dental Medicine, Farmington, Connecticut, USA.Keivan Zoufan , DDS, MDS, Diplomate, American Board of Endodontics, Private Practice, Zoufan Endodontics, Los Altos and Cupertino, Assistant Professor of Dental Diagnostic Science, University of the Pacific, Arthur A. Dugoni School of Dentistry, San Francisco, California, USA.
