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ePaper created 2018-03-06, 08:52:14 | version 1.38.0
Fig. 7 Fig. 8 Fig. 9 Fig. 10 Fig. 7: A small field of view CBCT scan confirmed the outcomes of the surgical procedure and root canal therapy. Fig. 8: Two-year follow-up radiograph. Fig. 9: CBCT scans showing the root migration above the nerve, allowing for safe extraction to be performed. Fig. 10: Comparison of the immediate post-op situation and the situation at the two-year follow-up. Case presentation A female patient in her mid-twenties was suffering from typical partially erupted third molar complications (Fig. 1). Extraction was advised in order to relieve the patient. A preoperative radiograph was taken (Fig. 2) for the surgeon and endodontist to discuss the shape of the roots and the IAN proximity. At the request of the endodontist, a CBCT scan was performed (i-CAT), as is advised prior to any surgery (Fig. 3). The cross sections revealed an intimate relation between the mesial root and the nerve, and thus indicated that any surgery at this point could cause some trauma to the nerve. The situation was explained to the patient, who was very concerned about the potential injury to the IAN. However, the patient presented with acute pain, which would require treatment, possibly antibiotic therapy, which in the future would be her go-to in case of a flare-up. This was defi- nitely not an ideal solution, especially in view of the efforts currently being undertaken by the European Society of Endodontology to limit antibiotic prescription for root canal therapy to a reasonable and evidence-based minimum. The alternative solution in such cases is coronectomy. From discussing this option with the surgeon and study- ing carefully the radiographs and CBCT data, it was clear that, if the surgeon was to cut the crown below bone level, pulp exposure and partial pulpectomy were inevitable. Therefore, in order to minimise postoperative complica- tions, the decision was made to perform a root canal ther- apy on the third molar to reduce the risk of pulpitis or infec- tion in the apical part. The patient agreed to this solution. root canal shaping. During the treatment, one periapical radiograph was taken (Fig. 4) and it showed the curve on the mesial roots. Irrigation was performed very safely with the EndoVac unit (Kerr), as any extrusion of sodium hy- pochlorite could have severe consequences for the nerve and the apical area. The root canal therapy was com- pleted in a single visit (Fig. 5), following which the surgeon performed the coronectomy. A bitewing radiograph was taken to check the level of the coronal part after the ex- cision and confirm that it was completely under the bone level (Fig. 6). A reinforced glass ionomer was used to seal the roots, and sutures were placed and left for one week. A small field of view CBCT was taken to check the post- operative outcome of the procedure (Fig. 7). Two years after the treatment, the patient returned to the clinic complaining of some pressure sensations in the area. A CBCT scan allowed us to investigate the situa- tion, and it revealed a pleasant surprise: the tooth had mi- grated coronally and gone above the nerve (Figs. 8 & 9). We explained to the patient that the remaining part of the tooth had moved towards the gingival level, which was why she was feeling pressure, and now it would be safe to remove the remaining tooth. The surgeon performed the intervention. Figure 10 shows how much the tooth had migrated over the two years and demonstrates the absence of any infection under the roots. Editorial note: A list of references is available from the publisher. contact Endodontic treatment was performed using the TF Adaptive SM (small/medium) procedure pack (Kerr) for Dr Philippe Sleiman is an assistant professor at the Faculty of Dentistry of the Lebanese University in Beirut in Lebanon. He can be contacted at profsleiman@gmail.com. roots 1 2018 17