Dentaltown September 2022 - 23
message board
Please Help! Very Stressed
About a Possible Failing RCT
Townies mitigate a possible endo disaster and OP closes the case with a fi nal update
harvestrain
Member Since: 03/27/13
Post: 1 of 67
I had an emergency patient with excruciating pain come in on a Saturday needing a RCT
on #14. She was seen by another dentist and was referred to an endodontist but no endodontist
could see her for at least a month. I tested the tooth; pulp was necrotic. I initially did an emergency
pulpectomy on #14 and subsequently fi nished the RCT and placed a crown in November.
Patient was feeling great after the RCT. Two days ago, she called with heat pain and getting
better with cold. I started her on antibiotics. Today, she called back saying the pain is getting
worse. We asked her if she thinks it is a neighboring tooth; she said she thinks so but doesn't
know. I am very stressed. She is coming again on Saturday and wants me to fi x whatever is
hurting her.
From the attached X-rays, can someone give some guidance if RCT is failing or done poorly
and needs re-treatment, or if there is a possibility it could be a different tooth? I have never done
a re-treat of a molar. Please help! ■
1/6/2022
Profi table GPs
Member Since: 05/14/19
Post: 2 of 67
Can't see everything, but your endo looks fi ne. Sometimes after dental work, gingival irritation
spreads into the PDL and causes endo-like symptoms.
Have her fl oss that tooth four to fi ve times a day and rinse with warm salt water after. It
should feel better right away and should get resolved after a couple of days unless something
major is wrong with the tooth. But start with this. ■
1/6/2022
Danishteeth
Member Since: 10/30/19
Post: 3 of 67
Had this happen numerous times. As a new grad, the fi rst thing I thought: " OK, so this is
my fi rst failing endo. Part of life, but I hate it. " Then the patient comes in, we test the teeth and
so far it has always been another tooth. Just make sure you aren't just prescribing AB without
testing. Your endo looks great. However, a determining factor beyond obturation is if you've
irrigated enough. Other possibilities: It might be a split tooth; they can sometimes be hard to
diagnose and we end up doing the endo. Always ask yourself, " Why does this tooth need endo? "
It seems like it has a cavity on the occlusal surface-have you removed all of it? On postoperative
photo, it could look like there's some left. Fingers crossed it isn't that tooth. ■
1/6/2022
24 SEPTEMBER 2022 // dentaltown.com
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