First Endo

[Jess24]

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I did my first endo two months ago. It was on a first upper premolar, two canals. The tooth was with secondary caries under an amalgam. The patient arrived to me two week after his face was swollen and he went to a dentist who did him some debritment. he didnt do the endo with that dentist because he didnt have any money do he went to the students clinic.
So i took an xray and the tooth had a big periapical process.
Inmediatly i started the endo treatment. I did the opening, and i had to build one of the proximal walls with glass inomer because it was completly destroyed. I didnt finished the treatment in the first meeting so i put calcium hydroxide and closed it with IRM. A week after that i finished the treatment and closed the canals with guttapercha. One of them was a little short acording to one of my instructors, but other instructor said it was ok, because it was the length i worked with.
Two weeks ago, the patient came because the filling fell off. It was the part of the glass ionomer on the proximal wall. I took everything off including the irm and filled it all with glass ionomer. I also did and xray and it seemed to be ok, the processes seemed to be getting smaller.
Yesterday he called me and said it is swollen again, like the first time.
What happened here??
He is coming to the clinic on monday, and i dont know what can be the reason that its swollen again.
i just hope i didnt ruined him his tooth.

 

[jmick101]

I did my first endo two months ago. It was on a first upper premolar, two canals. The tooth was with secondary caries under an amalgam. The patient arrived to me two week after his face was swollen and he went to a dentist who did him some debritment. he didnt do the endo with that dentist because he didnt have any money do he went to the students clinic.
So i took an xray and the tooth had a big periapical process.
Inmediatly i started the endo treatment. I did the opening, and i had to build one of the proximal walls with glass inomer because it was completly destroyed. I didnt finished the treatment in the first meeting so i put calcium hydroxide and closed it with IRM. A week after that i finished the treatment and closed the canals with guttapercha. One of them was a little short acording to one of my instructors, but other instructor said it was ok, because it was the length i worked with.
Two weeks ago, the patient came because the filling fell off. It was the part of the glass ionomer on the proximal wall. I took everything off including the irm and filled it all with glass ionomer. I also did and xray and it seemed to be ok, the processes seemed to be getting smaller.
Yesterday he called me and said it is swollen again, like the first time.
What happened here??
He is coming to the clinic on monday, and i dont know what can be the reason that its swollen again.
i just hope i didnt ruined him his tooth.

Sounds like it might be a couple things.

If the filling fell of and the root canal was exposed for a period of time it may have become infected again and may necessitate re-treatment.

The flare up could be a result of instrumentation and plugging up a drainage route. I assume that this fella was put on anti biotics right?

If it was me I would recommend retreating (because of the contamination) and putting him on course of antibiotics with a good anaerobic spectrum (for the chronic lesion).

Just my 2 cents.

 

[Jess24]

I just talked to the patient again.
He says now its not that swollen, but more than on the other side. And he also feels the site where the debritement was done with a cut its open again, but no liquid is coming out.
Now he didnt want to come to the clinic on monday because nothing hurts him, but i convinced him to come anyway.

 

[DrJeff]

More often than not I've found over the year that if you have what is deemed an acceptable fill obturation wise and you see recurrent "flares up" from the tooth that 1 of 2 things is going on:

1) Root fracture - likely vertical, very often tough to see/diagnose

2) Missed canal/short fill

If it's #1, well that tooth is a goner. If it's #2, retreat, making sure you're all the way to, if not slightly past the apex, doing the retreat over 2 visits with calcium hydroxide in the canals in between visits.