Understanding non-resolving symptoms
Jon Richards DDS MS
This is an all-to-common scenario. A average radiographic-appearance, but continuing symptoms after root canal therapy. In this case, the initial treatment was completed approximately 6 months ago. It was a lot of work for one day: root canal, core buildup, and crown- all in a single visit.
The patient’s symptoms were continued pain to thermal stimulation, mostly an ache after hot foods and liquids. He also avoids chewing on that side because of tenderness with biting.
At this point in time, the patient is not only in pain, but frustrated because there seems to be no apparent cause. Common misconceptions include: “This tooth can’t hurt like this, it’s had a root canal. Right?” or “It has to be the one next to it, this one can’t feel pain anymore.”
In reality, ANY root canal treated tooth is a candidate for continuing issues. The nature of this pain would suggest possible untreated canal anatmoy is present. Percussion tenderness was confirmed, but the sensitivity to hot could not be reproduced clincially.
CBCT analysis showed an untreated MB2 canal (again…), but no other abnormalities could be detected.
After access, the canal was located and found to be a seperate canal with its own portal of exit. All the other canals were retreated in this case, as the MB and DB canals also required additional length to reach their respective termini.
Following one month of Ca(OH)2, symptoms were confirmed to be completely resolved. Following obturation with warm gutta percha and sealer, the crown was repair in our usual manner. This includes hydofluoric acid etch of the porcelian, silane, dual-cure resin core veneered esthetically with a filled resin occlusal.