Inadequate treatment: a pathway to surgery.
Oral Surgery, Oral Medicine, and Oral Pathology
|May 1, 1985
Summary
A missed third root on a maxillary first premolar caused persistent endodontic pain. Surgical intervention, including apicoectomies and retroseals, successfully resolved the pain after conventional root canal therapy failed.
Area of Science:
- Dentistry
- Endodontics
- Oral Surgery
Background:
- Persistent endodontic pain can arise from undiagnosed root anatomy.
- Maxillary first premolars can present complex root configurations, including a third root.
- Full coverage restorations may complicate endodontic retreatment.
Observation:
- A patient experienced postendodontic pain three years after root canal therapy on a maxillary first premolar.
- Radiographic examination revealed an impacted second premolar had previously obscured a third root of the first premolar.
- The unfilled third root was inaccessible for conventional endodontic retreatment due to the full coverage restoration.
Findings:
- Apicoectomies and retroseals were performed on all three roots of the maxillary first premolar.
- The surgical intervention addressed the previously untreated third root.
- The patient became asymptomatic following the procedures.
Implications:
- This case highlights the importance of thorough radiographic interpretation in endodontics.
- Surgical endodontic procedures can be effective for treating complex root anatomy missed during conventional therapy.
- Identifying and treating all root canals, even in restored teeth, is crucial for long-term treatment success.
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