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Case Challenge

By Mary Um, D.M.D., M.S.

An 82-year-old white female presented with chief complaint of, “I still have a dull ache in that tooth six months after I had the root canal done.” The patient reports mild throbbing ache from tooth #15. No swelling or deep probing depths noted. Occlusion was checked and no interferences or other malocclusion noted.

Med Hx: ASA II: Heart condition (A-fib 2010), Allergic to – sulfa, iodine dye. Adverse reaction to epi. Sciatica pain

Surgical Hx: None

RX:  None.

Allergies: sulfa, fondine dye

Hx current illness: #15 RCT was completed six months ago. Pre-op diagnosis was Symptmatic Irreversible pulpitis and symptomatic apical periodontitis. She initially reported moderate to severe pain to temperature changes and biting pain. Patient reports that the nature of pain has changed since the root canal has been completed but has not resolved.  Now, the pain is mild, dull, and achy. The tooth was restored with a composite build-up and taken out of occlusion, but symptoms did not resolve. Patient spends her winters in Florida and had a endodontist and periodontist in Florida evaluate the tooth clinically and radiographically but no one could come up with a diagnosis.

Periapical radiographic did not reveal any abnormalities. CBCT scan shows B canal is not centered. It suggests that there is a possible mid-root split in the B canal. Remainder of CBCT scan is unremarkable.

12 14 15
Cold - + -
Palp - - +
Perc - - +


Probing depth: 3-4mm circumferentially.

Pre-op PA from 2018
Pre-op PA from 2018
Master cone PA from 2018
Master cone PA from 2018
Post-op PA from 2019
Post-op PA from 2019
Post-op CBCT
Post-op CBCT

Case Challenge Poll

Results from June 2019 Case Challenge Poll:

In the June 2019 Case Challenge, we asked readers to identify which of the following treatment options was best:

A. Treat MB2
B. Retreatment of the entire case
C. Periapical surgery
D. Extraction and replacement

Forty percent of you chose the best answer, B. Retreatment of the entire case, while the other 60 percent chose A. Treat MB2. Thank you for providing your input!