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Case Conference Endodontics Supporting Your Practice

Oasis Case Conference – failed root canal treatment on 16. What’s your diagnosis?

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Mary's PicThis case was submitted by Dr. Mary Dabuleanu from Dabuleanu Dental

A CDA Oasis Case Conferences is a two-part presentation of a clinical case. In Part 1, we invite you to watch the short video of the case and provide comments about a possible diagnosis and treatment. You will also have the opportunity of submitting any questions you might have related to the case*. In Part 2, the case presenter shows how the case was managed and answers key questions.  

 

* When you submit comments and questions in conjunction with Part 1 of the case conference, they do not go live on the Oasis Discussions website. They are received and moderated by the Oasis Team . Summaries of the comments are compiled and posted in the second part of the case presentation and key questions will be forwarded to the clinical presenter for consideration.  

Case Video Presentation (2.40 min)

 

 

xray2 (1)

Periapical radiograph showing 16 with endodontic treatment completed 5 years previously  

What do you see on the radiograph?

What is the differential diagnosis of this case?

Have you any questions for Dr. Dabuleanu?

 

 

13 Comments

  1. Kim scott December 9, 2014

    Short short short / sure also missed mesiobuccal 2 as well. Complete retreatment.

    Reply
  2. Dr Morris Fremar December 9, 2014

    Treatment would be conservative endodontic re treatment.I would remove the gut ta percha on all three canals and fill to the apex with the aid of an apex locator and radiographs.I would look for a second medial buccal canal.Of course if there is a vertical fracture the retreatment would be hopeless.After retreatment a crown would be appropriate for cusp protection.

    Reply
  3. Richard Gilsig December 9, 2014

    There is not enough information for me to proceed with treatment. More data needed.
    Next step: Off angle periapical X-rays.
    And the radiopacity in close proximity to the palatal apex and sinus floor needs to be investigated. Could this be a fixation device? Might there be an oral-antral fistula? (easy to check)

    Reply
  4. Anonymous December 9, 2014

    endo retreat is obvious answer for initial attempt at fixing it, but seeing the cost of retreat, then core, then crown, just take it out, let heal, throw in a implant and restore,, done,, retreats fail as well

    Reply
    1. Dr. ron corber December 10, 2014

      Did you just say “throw in an implant”? I thought it was a surgical procedure. I would also like to say that given the width of the molar, you may find that implant and crown placement will lead to embrasure/food impaction with consequent periodontal and caries issues on either #15 and #17. Would this be included in your success rate for the implant? I counsel most patients that natural periodontal attachment cannot be duplicated as well with implants.

    2. Naghmeh Vadovic December 11, 2014

      I think that the option of extraction and implant placement has to be presented to the patient; however re-treatment followed by a crown will provide the more cost effective treatment option. In my opinion this tooth does not need a post. The function of a post is to retain the core. There is more than enough tooth structure here to fully retain any core material.

  5. Elaine December 9, 2014

    There may be a separated instrument in the palatal canal of 16. The distobuccal root filling appears to be short of the apex. I do not detect evidence of a filled mesiolingual canal. The short roots appear consistent with orthodontic-related apical resorption but the patient history would need to confirm this. I think that there is bone loss in the furcation region by extension.

    Reply
  6. Anonymous December 9, 2014

    Sure looks like a broken file at the apex of the palatal canal. Is it? What are the chances of success if retreated?

    Reply
  7. Dr Sam Al Fasih December 9, 2014

    Pulpal floor perforation is possible cause for failure, if so extraction is the treatment

    Reply
  8. P Neilson December 9, 2014

    I don’t believe this is “just” a simple failed endo due to underfill or missed canals. There are bone screws and a plate superimposed on the sinus, and the jagged outline of the palatal root, and diffuse radiolucency of the mid palatal root, suggest a fractured root, or trauma, or surgery (orthognathic?) in the past. There may also be a subsequent resorptive process going on here. If it is confined to the palatal root, a retreatment of the buccal canals and root amputation of the palatal root might be possible. If not, then extraction and replacement with a prosthetic alternative would be in order.

    Reply
    1. Anonymous December 10, 2014

      Agreed. There also seems to be MB root involvement #17. More to the story. Past trauma may be playing a bigger role.

  9. Rob pasch December 10, 2014

    Send the patient out for a CbCt scan of the area and treat accordingly.
    Potential for complete re treatment exists, but need more diagnostic information.

    Reply
  10. Andrew Schmidt December 12, 2014

    Radiographic observations
    – separated instrument in palatal canal, possible lentulo or file
    -large direct restoration on a RCT molar post endo
    – Short fill on DB canal
    -prior fixation device possibly overlying radiolucent area

    DDx

    -separated instrument palatal canal, inadequate fill and reinfection
    – cracked tooth
    – failing RCT inadequate fill on DB/palatal
    – rct reinfection/spead and complication to fixation device

    Reply

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