Case Report

Danielle Wingrove

39 year old Caucasian female presented for evaluation and treatment of tooth #12.

SUBJECTIVE

Chief Complaint:  “My dentist did the pre-treatment for the root canal and it needs to be finished.”

Medical History:  The patient states that she is allergic to codeine in which her throat swells, she gets hives from any adhesive and she gets mild contact dermatitis from latex.  She has a history of gastric by-pass surgery and a lumpectomy of her breast.  She smokes 1 cigarette a week as she is trying to quit.  She was diagnosed with sleep apnea but does not take any medication and does not require any treatment.  She was also diagnosed with Borderline Personality Disorder but takes no medication for this condition.  She is currently on no medications. 
BP- 110/61 P- 73

Dental History: The patient was referred to the Graduate Endodontic Department at OHSU and was seen in September 2007.  She reports to having a swelling associated with #12 and was given antibiotics but no I&D was performed.  Her general dentist accessed #12 but was unable to finish the tooth and she was referred to OHSU.

OBJECTIVE

Extra-oral Exam: WNL.  No swelling, lymphadenopathy, or asymmetry.

Intra-oral Exam: WNL.  No swelling or sinus tract.  #12 had IRM in the access and DO composite, #13 has MO amalgam and #14 has MODBL amalgam.

Diagnostic Findings:

Radiographic Interpretation:

#12 with periapical radiolucency and DO composite with IRM in access.

ASSESSMENT

#12 Pulpal- previously initiated treatment
       Periapical- Symptomatic apical periodontitis with PARL

PLAN

Recommended completion of the NSRCT #12.  Explained all risks and complications of treatment such as separation of files, perforation of root, unable to locate canals or to get around the curve or obstruction if present.  Patient understood and consented for treatment.

TREATMENT

First appointment: Administered 1 carpule 2% lidocaine with 1:1000K epi and 1 carpule 3% carbocaine.  Isolated the tooth with rubber dam and removed existing IRM.  Accessed into 2 dry canals with a pungent odor.  Canals were flared with Gates Glidden drills #2-4.  K hand files #10 and #15 were instrumented in presence of RC Prep to establish working length using the Root ZX2.

Working Length:  B- 22.0 mm
                           L- 21.0 mm

Canals were then cleaned and shaped.  First orifice shapers 50/.07, 40/.06, and 30/.04 were used in the coronal 1/3.  Canals were then cleaned and shaped using Profile .04 hand files to a size 30/.04 in each canal.  The canals were irrigated between each instrument alternating with 5.25% NaOCl and 15% EDTA.

The canals were then rinsed a final time with 15% EDTA followed by .12% CHX as final rinse.  The canals were then dried with paper points and the canals were obturated with gutta percha and Kerr EWT sealer using warm vertical compaction.  A sponge was placed over the gutta percha and the tooth was restored with IRM.

The patient was instructed to return to her general dentist for a build-up and crown.  The patient is due to return to the graduate endodontic department in March for a 6 month re-evaluation.