Not every endodontic case has a smooth "glide path"
Terry Pannkuk, DDS, MScD – Clinical Endodontic Technique Instruction, Cleaning and Shaping
Not every endodontic case has a smooth "glide path"
3 comments
1. In my opinion, the mesio-lingual canal was likely strip perforated from the continued attempt to negotiate to the same length as the MB canal. The first indication that the file was short of the MB canal, a radiograph should have been exposed. If the orifices to the medial canals in the chamber were close together, that could have been an indication that the canals joined in the middle to apical third of the root. Also the size 40 cone and the lack of curvature of the cone in the canal and the hemorrhage is an indication that there was a strip perforation. Does it matter? There is no mention of the endodontic diagnosis. If this was a asymptomatic, vital case and the patient remains asymptomatic after treatment, it doesn't matter but the patient should be informed Thy this could be perforated. If the patient is symptomatic from a periaical diagnosis, this may be a problem with post operative pain, which could lead to surgery. If the medial root was completed conservatively, again it depends on the diagnosis and then patient's symptoms. I would have considered decreasing my length by 2 mm under the assumption that they was a perforation in the ML canal. A CBCT would have been helpful in this case as well.
The patient was informed it was likely a false path perforation. There was reported jaw muscle soreness the next day (2/6/2015) but no tooth pain. The initial diagnosis was a stressed pulp with acute periradicular pulpitis consistent with a cracked tooth syndrome (moderate percussion sensitivity with a sharp transient response to cold thermal stimulation. An external mesiodistal crown fracture was noted with transillumination but did not extend into the root when observed microscopically during access. Routinely I schedule 5 year recall exams but I planned a 1 year recall for this patient. He did not schedule the recall exam and I plan to have my office manager call and attempt to schedule him on Monday. This was a very good debate case relevant to Dr. Herbranson's webinar today. Thank you so much for taking the time to comment. I will send you a free registration code for Dr. Hebranson's webinar recording which should be out in approximately 2 weeks, you can receive 2 hours of CE.
If we can get him in for a recall examination, I'll make sure this post is updated with the recall data.