Its very easy to listen few symptoms from patient and opting root canal treatment for a tooth. But sometimes its dilemma and diagnosis itself takes more than one or two visits. 58 years male patient came to our clinic with complain of severe sensitivity in all teeth. there were few class V cavities and generalized attrition. He had history of hypertension and taking treatment for the same. We started with restoring class V cavities and prescribed anti-sensitivity toothpaste. Follow up visit after one week, there was almost 50% relief in sensitivity but upper left back teeth had more sensitivity. I checked with sensitivity on individual tooth one by one and found 26 more sensitive compared to other teeth in the arch. This is how we apply methylene blue:
Methylene blue dye is applied for 10-20 seconds and then rinsed. Caries detection dye can also be used in place of methylene blue if not available.
First I replaced class V filling as it was not looking good after staining. Then patient was recalled after one week.
Recall visit after one week: No relief in sensitivity in tooth 26. Other teeth were all fine with no or very little sensitivity. We had to plan 26 for root canal treatment seeing no benefit of waiting even more.
I would have limit the access cavity towards distal side preserving more of oblique ridge, but I had to cut more a bit to remove the pulp stones.
Finding MB2 was quite easy here.
A small pulp stone was adherent to on pulp floor just near to palatal canal orifice. I always try to remove pulp stone before entering into canals. Otherwise, if we try to remove at the end of canal preparation, part of pulp stone can go inside the canal and stuck there making treatment difficult. Ask me, how I know!
Obturation, WVC with GP and #Pulp_canal_sealer (EWT).
First layer of #colored_composites, it is very helpful if we have to re-treat this case in future.
Composites as post op restoration. I would not do crown on this tooth, I will keep follow up every six months and if required #Emax #overlay will be restoration of choice.
MB1 and MB2 had different portals of exit. If they merge in between then protocol for shaping change. We'll discuss that in coming cases. Thank you for your valuable time. Please put your comments and suggestions.
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