Acute Pulpitis - Root Canal Treatment

peri-apical xray 

A 29 year-old-male came with complaint of severe pain in his lower right molar. He said that he experienced (intermittent) pain for about a month and would just take NSAID (Non Steroidal Anti-Inflammatory Drug) then for two consecutive nights he had this throbbing pain before he came to our office. Upon visual examination revealed of cracked restoration. Radiographically the periapex is normal. Diagnosis: Irreversible pulpitis.

 

tooth no. 46  

the caries weakened the cement filling 

to check my work I place LED/halogen light cure at the buccal side. still at the roof of the pulp chamber. These holes are the pulp horns

access the canal with no.10 files

to flare the coronal third of the canal, Gates-Glidden reamers were used  

Irrigated with saline and chlorhexidine gluconate 0.20%

Denstply AH Plus and gutta percha : Voco Rebilda

gingival retraction

porcelain fused to metal

Pain in her porcelain fixed bridge

A 56 year old female came to my office and complain of pain in her tooth no. 34 and 35.

Upon dental check-up, there's a 3 unit porcelain fixed bridge on these two teeth. It was the main support that resulted in a cantilevered bridge. As you can see in my first x-ray, there's an overhang unit after tooth no 35. That cantilever or the unsupported unit had put pressure on tooth no 34 and 35. It caused microscopic leakege sipping to the abutment tooth due to the seesaw effect during mastication. There was no dramatic seesaw effect but the movement was in microscopic effect.

I removed the unit and did a root canal therapy on tooth no. 35 (AH Plus). On tooth no. 34, I did the pulpotomy using the new medicaments Pulpotec from Switzerland. I prepared those teeth for their porcelain cap. My patient is still pain free and problem free with her new unit since 2009. I gave her oral health instruction to follow and do religiously to maintain a healthy gums.