Root Canal Hurts Again 2 Years Later When I Bite on Food

While all is non equal with x-rays and a cone beam, having both tools available is a priority for me. However, sometimes, fifty-fifty these tools don't testify the whole film. Why?

Well, people always say "Don't gauge a book by it's embrace."

I always say, "Don't gauge a molar past its ten-ray."  Likewise, don't assume the worst. Requite things a chance.

That'southward how I practice endodontics. I never say "never," and I always give teeth a gamble. I won't know if something is going to work until I endeavour. Let's look at a specific case that highlights the need for both tools!

Patient: 35 year old woman with pain in a molar that had already had a root canal

Diagnosis: Previously Treated and Symptomatic Apical Periodontitis

X-Rays and a Cone Axle: I Do Both

My philosophy served a recent patient well. She came to me as an emergency case, experiencing lots of pressure level and pain on a tooth that had already had a root canal. Usually, I try non to "meet and treat" my patients, because I demand time with them — they have questions that I desire to respond. I like to brand sure the patient understands their treatment and treatment options, and I want to make certain I am treating the right tooth.

Getting the patient to empathise the why is cardinal, and that takes communication, transparency, and patience.

Nevertheless, if the patient's pain is characterized by intense pressure, and they are in tears, I reassess the situation and treat immediately. I know that their tooth is trying to drain, and I want to make that happen for them.

When a patient comes to me and their tooth already had a root canal, my protocol is to take not just x-rays only a cone beam as well. (Now do you lot see why x-rays and a CBCT go hand-in-manus? Or at least in MY practice, they practise!)

Unlike Pictures: X-Rays and Cone Beams

Some dental professionals would accept said that the cone beam was suggestive of a vertical root fracture…  and that was possible (and most definitely a part of my differential diagnosis). But I could not be certain.

The 10-ray imaging looked like the previous root canal had been done well. Merely since I had no history of the tooth — and the patient didn't remember any details — I had to keep in mind that information technology was possible that the tooth had a new bacterial infection that had nothing to do with a crack. It can be easy to blame pain and infections on cracks when treatment isn't working, simply leaner is a more than likely culprit.

So Many Unknowns

There are so many variables I did not know about the initial treatment. Was a prophylactic dam used? Was full-forcefulness sodium hypochlorite used? How long did information technology have the patient to get her crown?

I gave the patient her treatment options: retreatment with another root culvert, or extraction with an implant. I explained to her that, even if she chose a second root canal, I could find a fracture in the tooth and it would nevertheless need to be extracted. She wanted me to try it anyhow. Complete transparency before starting procedures is extremely of import to me and to my patients.

When X-Rays and a Cone Beam Aren't Plenty

What I constitute surprised me. I opened the tooth to find black, black and black. I was then surprised to run across the level of infection in the molar. The gutta percha was and then contaminated past infection that information technology turned black.

In one case I removed the gutta percha, the infection started to bleed.  And THIS is the key to helping a patient feel amend. Instant gratification for both me and my patient.

An Informed Decision

I understand that there's a learning bend to reading cone beam images, and they can be misinterpreted. Some would have thought to take this tooth out considering of a possible fracture (since root fracture can crusade pain afterwards a root canal ).

If you're not 100% definitive in the cause of root culvert failure, then access the tooth for a visual assessment to exist sure. Sometimes nosotros don't know the respond before going into the tooth. But if you fix your patient for the potential outcomes, then yous have given them the selection to have the chance with you.

Thankfully, I had both the ten-ray and the cone beam images to help inform me. Every tool and process plays an important function, and the more you stick to your gut and evaluate the different options, the amend adventure yous have of saving teeth. (That said, don't forget the "sticking to your gut" part, because your tools may not always show you everything.)

X-Rays and a Cone Beam Image: Each a Part to Play

The cone axle for this patient did non wait good, but if I had judged the tooth by its x-ray, I would accept done a total disservice to this patient. It would've been a complete misdiagnosis, considering the root canal infection didn't show up on the Ten-ray.

I was lucky that the patient wanted to try and relieve the tooth. It was the right pick for her and her wellness.

In Conclusion

Always be transparent with your patients. Give them all their options — and the "why" backside each option. If you rely solely on an x-ray to diagnose, you can make the incorrect choice. Use all the information and clues you accept.

Call back, a tooth tin be contaminated, yet that won't show up on x-rays and a cone beam. (In fact, I would recommend you assume that it's contaminated over just trusting what the images say.) Be open to stepping outside your standard operating process if it allows you to amend serve a patient… especially i who is in pain.

For additional tips and resources, make sure to connect with me on Facebook , Instagram , or Linked In .

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Source: https://soniachopradds.com/blog/endodontic-case-study-never-judge-a-tooth-by-x-ray/

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