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! Department of
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Endodontics
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Postgraduate Program in
! Endodontics
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Case Book
! Christine Westlie Bergman
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! Spring Semester 2014
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!
 Table of Contents
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 Case 1

P./B*'%$,F($N(+()&-M%(,+Q&//+)F(0*'$"#(,$/+)
D)."6&%$./%*"&";f"O.&05"('-"&5$&/"<.2&'.*"4&5"0.<.00.-"%("%)."G.6&0%2./%"(<"X/-(-(/%$:5"<0(2"%)."
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Z$8>"!>!"F""Z0(/%&'"7$.4"!=>!,>,H!H"

Chief complaint Radiographic findings

D./-.0/.5" 4)./" -0$/C$/8" 4&02" &/-" :('-*" " "
&/-"E$%$/8"&%"%((%)"!+>""
"

"
Z$8>"!>,"j"U::'15&'"&/-"E1::&'"7$.4"!=>!,>,H!H"

Medical history
T("2.-$:&'")$5%(0O"( "
Z$8>" !>3" j" \$5%(0Oa" @.0$&6$:&'" 0&-$(80&6)" E.<(0." &:1%."
%0.&%2./%"&%"%)."`%1-./%":'$/$:"F",c>!!>,H!H"
Dental history
"
9&0$.5" 80&-." I*" %((%)" !+>" D0.&%.-" &:1%."
,c>!!>,H!H" &%" %)." `%1-./%" :'$/$:" &%" %)."
G.6&0%2./%" (<" 9'$/$:&'" G./%$5%0O" &%" %)."
Y/$7.05$%O"(<"U5'(""

Clinical findings
"
D((%)" 7=( 78( 75(
9('-" n.5" n.5" n.5"
X@D"""HFfH" I3" 3;" 3I"
@&'6&%$(/" T(" T(" T(" "
Z$8>"!>;"F"@.0$&6$:&'"0&-$(80&6)"F"!=>!,>,H!H"
@.0:155$(/" n.5" T(" T(" "

Q(E$'$%O" T(" T(" T(" Tooth 15

@@G" I"22" ;"22" ;"22" F A&-$("(6&B1."0.5%(0&%$(/"QU"
" F D)." '&2$/&" -10&" :&/" E." <(''(4.-"
4$%)(1%"-$5016%$(/"
Tooth 17
" F A.5%(0&%$(/" $/" -$5%&'" &/-" (::'15&'"
(00$<$:.5"
" ="
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4$%)(1%"-$5016%$(/>"" 60.6&0&%$(/>""A1EE.0"-&2"4&5"-$5$/<.:%.-"
Tooth 18 4$%)"H*IJ"9\d"$/"+HJ".%)&/('>"L(:&'$5&%$(/"(<"
F A&-$("(6&B1."0.5%(0&%(/"U" 3"0((%":&/&'5*"61'6F5%(/."&/-"E'..-$/8"61'6"
:&7$%O>"@1'6F5%(/."4.0."0.2(7.-"EO"LT"E100>"
Diagnosis X18./('"6.''.%"&/-"[AQ>"
@1'6&'S" lH;>H!" ?C1%%" $00.7.05$E'." "
61'6$%$5"
@.0$&6$:&'S" N$%)"/(02&'"'$2$%5""
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6.0$(-(/%$%$5"
"
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Z$8>"!>I"j"?::.55":&7$%O"&/-"E'..-$/8"61'6&":&7$%O"
"
!=>!,>,H!H"
"
Treatment options
Second visit
!> XK%0&:%$(/" 3" K" !*f" 2'" `.6%(:&$/.]>" " A1EE.0" -&2" 4&5"
,> T(/F5108$:&'"./-(-(/%$:"%0.&%2./%" -$5$/<.:%.-" 4$%)" H*IJ" 9\d" $/" +HJ" .%)&/('>"
Treatment plan A.2(7&'" (<" %)." [AQ" <$''$/8>" L(:&'$5&%$(/" (<" 3"
• T(/F5108$:&'" ./-(-(/%$:" %0.&%2./%*" 0((%" :&/&'5>" D)." 4(0C$/8" './8%)" 4&5"
@1'6.:%(2O"!+" -.%.02$/.-"4$%)".'.:%0(/$:"&6.K"'(:&%(0"&/-"
• @0(5%).%$:" %0.&%2./%" 4$%)" 6(0:.'&$/" 0&-$(80&6)$:"$2&8."PZ$810."!>=V>"
:0(4/"!+"&%"%)."1/-.080&-1&%.":'$/$:>" !
• 9(/%0('"
"
D)." 6&%$./%" 4$5)" %(" C..6" %)." %((%)" &/-"
&::.6%"%)."./-(-(/%$:"%0.&%2./%>"
"

Problem list
• ?/.5%).5$&"

Treatment progress
!
!=>!,>,H!H" Z$8>"!>="j"N(0C$/8F'./8%)"0&-$(80&6)"!,>H!>,H!!"
• 9'$/$:&'"&/-"0&-$(80&6)$:".K&2$/&%$(/>" "
• G$5:155.-"%0.&%2./%"(6%$(/5>" Third visit
• ?::.55":&7$%O" ?/.5%).5$&" ," K" !*f" 2'" `.6%(:&$/.]>" " A1EE.0"
!,>H!>,H!!" -&2" 4&5" -$5$/<.:%.-" 4$%)" H*IJ" 9\d" $/" +HJ"
• L((:&'$5&%$(/"(<"3"0((%":&/&'5" .%)&/('>" A.2(7&'" (<" %)." [AQ" <$''$/8>"
!c>H!>,H!!" @0.6&0&%$(/" (<" %)." 0((%" :&/&'5" 4$%)" _$(0&:.>"
• [/5%012./%$(/" Y5.-"./-('$<%"$/"%)."G_"0((%":&/&'>"@1'65%(/."
• UE%10&%$(/>" 2$8)%" (E%10&%.-" %)." G_" :&/&'" &/-" 2&-." $%"
!=>!!>,H!3"" -$<<$:1'%"%(":0.&%."%).":(00.:%"4(0C$/8"'./8%)>"
• 9(/%0('"j","O.&05" +
;%&1-4/&-#F+
Endodntic treatment - _$("A&:."&/-"./-('$<%"3"0((%":&/&'5"
Pulpectomy • Q_":&/&'S";H^H;",!"22"
First visit
• G_":&/&'S";H^H,"!I*I"22"
9'$/$:&'".K&2$/&%$(/"&/-"0&-$(80&6)$:" • @"9&/&'S"IH^H;",!"22"
.K&2$/&%$(/"4&5":&00$.-"(1%>"?/.5%).5$&!
+" "
 • [00$5&<.]"1'%0&5(1/-" After treatment
G1%)/&-#F+
• !J"T&U9'"o"!H"2'+J+!+J"XGD?"o"I"2'+
KA'".-'/(4+
• D)." :&/&'5" 4.0." -0$.-" 4$%)" 5%.0$'."
6&6.0"6($/%5>"
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<%)$(.-.*+.%3'(.-'/(4+
• `.&'.-"4$%)"[AQ"
"
"
Z$8>"!>!H"j"@.0$&6$:&'"0&-$(80&6)"!c>H!>,H!!"
"

Prognosis
Endodontic
- Z&7(0&E'."
Tooth
- Z&7(0&E'."
Restoration
- Z&7(0&E'."

Evaluation
" T(" :(26'$:&%$(/5" -10$/8" %)." %0.&%2./%>"
Z$8>"!>+"F"Q&5%.06($/%"0&-$(80&6)"!c>H!>,H!!"
" D).0." 4&5" 60(E'.25" %(" 0.:$7." 8((-"
&/.5%).5$&" -10$/8" %)." %0.&%2./%5>"
@1'6&5%(/.5"2&-."$%"-$<<$:1'%"%("8.%"8'$-."6&%)"
E.<(0."$/5%012./%&%$(/>"

Control - after 2 years

"

"
Z$8>"!>f"F"Z$/&'"0&-$(80&6)"!c>H!>,H!!"
"

Before treatment

" :(1'-"E."<(1/->"
Z$8>"!>c"j"@.0$&6$:&'"0&-$(80&6)"!=>!,>,H!H"
"
Z$8>"!>!!"j"@.0$&6$:&'"0&-$(80&6)"H=>!!>,H!3"
"
?%" %)." %4(" O.&05" :(/%0('" %)." 6&%$./%" )&-" /("
5O26%(25>" T(02&'" (0&'" 21:(5&" 4.0."
(E5.07.->" @0(E$/8" -.6%)" 4.0." $/" /(02&'"
'$2$%5>" T(" 6&$/" %(" 6.0:155$(/" (0" %(" 6&'6&%$(/"
A&-$80&6)$:" 5)(45" /(" 5$8/5" &6$:&'" 6&%)('(8O"
&/-" 4." :&/" <(''(4" '&2$/&" -10&" 4$%)(1%"
-$50(6%$(/>"
@?["!"
" f"
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%)."%((%)"!+>""
" :&/&'" %0.&%2./%" $/" %..%)" 4$%)(1%" &6$:&'"
Discussion
N)./" &" 61'6" )&5" %)." -$&8/(5$5" $00.7.05$E'."
61'6$%$5*"%)."61'6"$5"5%$''"7$%&'*"E1%"5("$/<'&2.-"
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&'(/." %)." 61'6" 4$''" .7./%1&''O" E.:(2."
/.:0(%$:*"&/-"%)./"E&:%.0$&"4$''")&7."&/".&5O"
&::.55" %(" %)." &6.K" &/-" 6.0$&6$:&'" 5%01:%10.5"
P!V>"N$%)"7$%&'"61'6.:%(2O*"%).":'$/$:&'"&$2"$5"
0.2(7&'" (<" %)." ./%$0." 61'6&'" %$551." 5)(0%" (<"
%)." &/&%(2$:&'" &6.K" <(''(4.-" EO" &" E&:%.0$&F
%$8)%*" E$(:(26&%$E'." &/-" 5%&E'." 0((%" <$''$/8>"
N$%)"%)$5"%0.&%2./%*"-$5.&5.-*"$/<.:%.-*"/(/F
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&6.K>"PIV"
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"
References
!> `$810-55(/" ?>" 9'$/$:&'" Q&/$<.5%&%$(/5"
&/-"G$&8/(5$5>"[/S"e05%&7$C"G"&/-"Z(0-"
D@>" X55./%$&'" X/-(-(/%('(8O*"
60.7./%$(/" &/-" %0.&%2./%" (<" &6$:&'"
6.0$(-(/%$%$5*" ,/-" .-$%$(/*" XG"
_'&:C4.''" Q1/C58&&0-*" UK<(0-" ,HHf*"
6",3IF,If"
,> \p05%.-F_$/-.5'.7" @*" Lp75:)&''" \>"
D0.&%2./%" (1%:(2." (<" 7$%&'" 61'6"
%0.&%2./%>" X/-(-(/%$:" D(6$:5"
,HH,a,S,;F3;"
3> Z(0-" @*" #$%&'" 61'6.:%(2O" j" &/"
1/60.-$:%&E'." 60(:.-10.>"
[/%.0/&%$(/&'" X/-(-(/%$:" h(10/&'"
!cf,a"!IS"!,!F!,="
;> `6q/8E.08" L>" X/-(-(/%$:" D0.&%2./%"
(<"%..%)"N$%)(1%"?6$:&'"6.0$(-(/%$%$5>"
[/S" e05%&7$C" G*" Z(0-" @" P.-5V>" X55./%$&'"
X/-(-(/%('(8OS" @0.7./%$(/" &/-"
D0.&%2./%"(<"?6$:&'"@.0$(-(/%$%$5*",/-"
XG" _'&:C4.''" Q1/C58&&&0-*" UK<(0-"
,HHf*"66"3!=F3;,>"
I> l.0.C.5" l*" D0(/5%&-" L>" L(/8F%.02"
0.51'%5" (<" ./-(-(/%$:" %0.&%2./%"
6.0<(02.-" 4$%)" &" 5%&/-&0-$M.-"
%.:)/$B1.>"h"X/-(-"!c+cS"IS"f3FcH"
`Wp80./" Y*" \&88'1/-" _*" `1/-B7$5%" R*"
N$/8" l>" Z&:%(05" &<<.:%$/8" %)." '(/8F
%.02" 0.51'%" (<" ./-(-(/%$:" %0.&%2./%>"
h"X/-(-"!ccHS"!=S";cfFIH;"
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 Case 2

P./B*'%$,F($N(/*N%(,+Q&//+)F('*"%)+/
D)."6&%$./%*"&"!+"O.&05"('-":&1:&5$&/"2&'.*"4&5"0.<.00.-"%("%)."G.6&0%2./%"(<"X/-(-(/%$:5"<0(2"&"
-./%&'"56.:$&'$5%":'$/$:"$/"U5'(*"<(0".7&'1&%$(/"&/-"./-(-(/%$:"%0.&%2./%"(<"%)."'.<%"2&K$''&0O"
:./%0&'*",!>"
"

Z$8>",>!"F""Z0(/%&'"7$.4"Hc>H;>,H!3"
"

Chief complaint Clinical findings

@&%$./%" )&7." %./-.0/.5" %((%)" ,!*" 4)./" "
-0$/C$/8" :('-" &/-" 4&02" -0$/C5>" D)." D((%)" 77( 37( 33(
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"

Radiographic findings
"

"
Z$8>",>,"F"U::'15&'"7$.4"Hc>H;>,H!3"

Medical history
T("2.-$:&'")$5%(0O"(
"

Dental history
?1815%" ,H!,a" %0&12&*" %((%)" ,!>" @&%$./%" 4&5"
6'&O$/8" 4$%)" 5C&%.E(&0->" D)." %((%)" ,!"
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6&$/" 5$/:." %)." %0&12&" 4)./" -0$/C$/8" 4&02"
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• 9(/%0(''"
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• 9(/%0(''"

Non-surgical endodontic
treatment - pulpectomy
First visit
" X/-(-(/%$:" .K&2$/&%$(/" &/-" 60.(6.0&%$7."
Z$8>",>";"F"@.0$&6$:&'"0&-$(80&6)"F"Hc>H;>,H!3"
" 6.0$&6$:&'" 0&-$(80&6)" 4&5" :&00$.-" (1%>"
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F D)." '&2$/&" -10&" :&/" E." <(''(4.-" -&2" 4&5" -$5$/<.:%.-" 4$%)" H*IJ" 9\d" $/" +HJ"
4$%)(1%"-$5016%$(/>" .%)&/('>"
Tooth 21
A.2(7.-" %)." :(26(5$%." &%" %)." E1::&'"
F \(0$M(/%&'"0((%"<0&:%10."&6$:&'"6&0%>" 510<&:.>" D)." 61'6" 4&5" .K6(5.->" N." -.:$-.-"
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F @?["!" ?-).5$7.*" 9(26(5$%." rF,IH" ?3>" @0.6&0&%$(/"
Diagnosis (<"%)."&::.55":&7$%O*"X18./('F6.''.%"&/-"[AQ""
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" "

Treatment options
• XK%0&:%$(/"&/-"$26'&/%5" "
• U0%)(-(/%$:" .K%015$(/" &<%.0" Z$8>" ,>I" j" ,!" E1::&'" &<%.0" 0.2(7.-" :(26(5$%."
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./-(-(/%$:"%0.&%2./%"
"
• T(/F5108$:&'" ./-(-(/%$:" %0.&%2./%"
&/-":(26(5$%."0.5%(0&%$(/>"

Treatment plan
• T(/"5108$:&'"%0.&%2./%"
• 9(26(5$%."
• 9(/%0('"

Problem list
• ?5.6%$:":(/-$%$(/5"
• 90(4/"F"0((%"<0&:%10."

Treatment progress
!c>H;>,H!3"
• 9'$/$:&'"&/-"0&-$(80&6)$:".K&2$/&%$(/>"
"
!!" "
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Second visit
?/.5%).5$&" 3" K" !*f" 2'" `.6%(:&$/.]" A1EE.0"
-&2" 4&5" -$5$/<.:%.-" 4$%)" H*IJ" 9\d" $/" +HJ"
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4(0C$/8" './8%)" 4&5" -.%.02$/.-" 4$%)"
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$2&8." PZ$8" ,>+V>" @0.6&0&%$(/" (<" %)." :&/&'5*"
4$%)" _$(A&:." 4&5" :&00$.-" (1%>" [/56.:%$(/" <(0"
7.0%$:&'"0((%"<0&:%10."4$%)"/.8&%$7."0.51'%>"
"
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rF,IH"?3"
- "

"
Z$8>",>c"j"@.0$&6$:&'"0&-$(80&6)"(<"QD?"!=>HI>,H!3"
"

"
Z$8>",>+"j"N(0C$/8"'./8%)"0&-$(80&6)"
!=>HI>,H!3"
"

"
Z$8>",>!H"j"Z$/&'"0&-$(80&6)"!=>HI>,H!3"

"

" !,"
 Before treatment Control – after 5 months
" "

"
" Z$8>",>!!"j"Z(''(4F16"0&-$(80&6)"I"2(/%)5"'&%.0"%&C./"
EO"%)."0.<<.0.-"-./%$5%>"
After treatment "
"
DISCUSSION
?":0(4/F0((%"<0&:%10."$5"-.<$/.-"&5"&"<0&:%10."
$/7('7$/8"./&2.'*"-./%$/"&/-":.2./%12>"D)."
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:(/%0&5%"%("0((%"<0&:%10.5"4).0."%)."<0&:%10."
Prognosis
$5"'(:&%.-"./%$0.'O"4$%)$/"%)."&'7.'(15"P!V>"
Endodontic
- Z&7(0&E'." "
Tooth A((%"<0&:%10.5*"-.<$/.-"&5"<0&:%10.5"$/7('7$/8"
- Y/:.0%&$/" -./%$/*" :.2./%12" &/-" 61'6*" &0." 0.'&%$7.'O"
Restoration 1/:(22(/" &2(/8" -./%&'" %0&12&5*"
- Y/:.0%&$/" :(260$5$/8" H*I" F+" J" (<" %)." $/W10$.5" &<<.:%$/8"
%)." 6.02&/./%" -./%$%$(/" P,V>" ?/-0.&5./" &/-"
Evaluation \Ws0%$/8F\&/5./" <(1/-" %)&%" /.:0(5$5" (<" %)."
D)." 61'6.:%(2O" (<" ,!" 4&5" 1/:(26'$:&%.-" 61'6" 151&''O" (::105" $/" %)." :(0(/&'" <0&82./%*"
&/-"&5.6%)$:":(/-$%$(/5"1/-.0"%)."%0.&%2./%" 4)$'."%)."61'6"(<"%)."&6$:&'"<0&82./%"0.2&$/5"
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" &::(0-$/8"%("%).":0$%.0$&"'$5%.-"EO"?/-0.&5./"
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References
!> ?/-0.&5./" h>U*" ?/-0.&5./" Z>Q*"
?/-.055(/"L>"D.K%E((C"&/-":('(0"?%'&5"
(<"%0&12&%$:"$/W10$.5"%("%)."%..%)>";%)"
X-$%$(/>" _'&:C4.''" Q1/C58&&0-*,HH+*"
6"3!;F33=>"
,> ?/-0.&5./" hU>" X%$('(8O" &/-"
6&%)(8./.5$5" (<" %0&12&%$:" -./%&'"
$/W10$.5>" ?" :'$/$:&'" 5%1-O" (<" !*,cf"
:&5.5>"`:&/-"h"G./%"A.5"!c+ca"+fS"3,cF
;,>"
3> ?/-0.&5./" h(*" \Ws0$/8F\&/5./" X>"
[/%0&F&'7.('&0" 0((%" <0&:%10.5S"
0&-$(80&6)$:" &/-" )$5%('(8$:" 5%1-O" (<"
IH":&5.5>"h"U0&'"`108"!c=+a",IS";!;F,=>"
;> r&:)0$55(/"_"Y*"h&:(E5./"[>"L(/8F%.02"
60(8/(5$5" (<" ==" 6.02&/./%" &/%.0$(0"
%..%)"4$%)"0((%"<0&:%10.>"`:&/-"h"G./%"
0.5*"!c+IS"f3S"3;IF3I;>"
I> 97.C" Q*" Q.Wt0." [*" ?/-0.&5./" hU>"
\.&'$/8" &/-" 60(8/(5$5" (<" %..%)" 4$%)"
$/%0&F&'7.('&0" <0&:%10.5" $/7('7$/8" %)."
:.07$:&'" 6&0%" (<" %.)" 0((%>" G./%"
D0&12&%('",HH,a"!fS"I+F=I"
=> ?/-0.&5./"hU*"?/-0.&5./"ZQ*"Q.Wt0."
&'7.('&0" 0((%" <0&:%10.5>" !>" X<<.:%" (<"
60.F$/W10O" &/-" $/W10O" <&:%(05" 51:)" &5"
5.K*" 5%&8." (<" 0((%" -.7.'(62./%*"
<0&:%10."%O6.*"'(:&%$(/"(<"<0&:%10."&/-"
5.7.0$%O" (<" -$5'(:&%$(/>" G./%"
D0&12&%('",HH;a",HS"!c,F,H,>"
" !;"
 Case 3

4&,5.*2"67-"8-,.82-6+9),,+'7-*+#)#.-:)23-'.%"'52)"#-
D)."6&%$./%*"&"=3"O.&05"('-":&1:&5$(/"2&'.*"4&5"0.<.00.-"%("%)."G.6&0%2./%"(<"X/-(-(/%$:5"<0(2"
%)."1/-.080&-1&%.":'$/$:*"<(0".7&'1&%$(/"&/-"./-(-(/%$:"%0.&%2./%"(<"%)."'.<%"2&K$''&0O":&/$/.*",3>"
"

Z$8>"3>!"F""Z0(/%&'"7$.4"!I>H!>,H!3"
"

Chief complaint Radiographic findings

T("5O26%(25"j" "

"
Z$8>"3>,"&/-"3>3"j"<0(/%&'"&/-"E1::&'"7$.4"!I>H!>,H!3"

Medical history
R'1:&8(/(2&"F"2&'$8/&/:O"
Medicines
Z0&82$/"
T1:'.&0"%0.&%2./%(
"

Dental history
D((%)",3S"?2&'8&2"0.5%(0&%$(/"-$5%&'*"&/-"
:(26(5$%."0.5%(0&%$(/"2.5$&'>"
"

Clinical findings 15.01.2013

"
"
D((%)" 33( 3<( 3;( Z$8>" 3>;" &/-" 3>I" F" @.0$&6$:&'" 0&-$(80&6)" F"
9('-" n.5" T(" T(" !I>H!>,H!3"
"
X@D"""HFfH" 3," fH" fH"
@&'6&%$(/" T(" T(" T(" Tooth 22
@.0:155$(/" T(" T(" T(" F A&-$(" (6&B1." 0.5%(0&%$(/" -$5%&'" &/-"
Q(E$'$%O" T(" T(" T(" 2.5$&'>"
@@G" ,"22" ,"22" 3"22" F D)." '&2$/&" -10&" :&/" E." <(''(4.-"
4$%)(1%"-$5016%$(/>"
Tooth 23
" F L(/8"0((%"
F A&-$("(6&B1."0.5%(0&%$(/"-$5%&'"

!I" "
 F A&-$('1:./%"0.5%(0&%$(/"2.5$&'""
F [00.81'&0" 0&-$'1:./:O" (7.0'&O$/8" %)."
0((%":&/&'"$/"%).":(0(/&'"6&0%*"4$%)"/("
(E7$(15".K%./5$(/"$/%("%)."0((%":&/&'>"
F G./%$/."E0$-8."(7.0"%)."0((%":&/&'>"
F D)." '&2$/&" -10&" :&/" E." <(''(4.-"
4$%)(1%"-$5016%$(/"
F @?["!"
Tooth 24
F X/-(-(/%$:" %0.&%.-" 4$%)" &-.B1&%."
0((%"<$''$/8"
F A&-$("(6&B1.":(0(/&'"0.5%(0&%$(/"
F D)." '&2$/&" -10&" :&/" E." <(''(4.-"
4$%)(1%"-$5016%$(/"
Diagnosis
@1'6&'" lH3>3!"[/%.0/&'"0.5(06%$(/"(0""
PlH3>3f"9.07$:&'"0.5(06%$(/uV"
@.0$&6$:&'" N$%)"$/"/(02&'"'$2$%5"
@.0$(-(/%&'" N$%)"$/"/(02&'"'$2$%5"
@?[" !""
" 4$%)"R1%%&6.0:)&"&/-"?\"b"5.&'.0>"
Treatment options
• T(/"5108$:&'"./-(-(/%$:"%0.&%2./%"
• XK%0&:%$(/"j"$26'&/%"(0"E0$-8."
• @.02&/./%" 0.5%(0&%$(/" &<%.0"
./-(-(/%$:" %0.&%2./%a" :(26(5$%." (0"
:0(4/"
• UE%10&%$(/"
Hf>H!>,H!;"
• 9(/%0('"j"!"O.&0"6(5%"(6.0&%$7."
Non-surgical endodontic
treatment - pulpectomy
First visit
9'$/$:&'" &/-" 0&-$(80&6)$:" .K&2$/&%$(/*" 6)(%("
&/-"$/<(02&%$(/"4&5":&00$.-"(1%>"D)."6&%$./%"
&::.6%" %)." %0.&%2./%" &/-" 4$5)" %(" C..6" %)."
%((%)>" ?/.5%).5$&" ," K" "#$%&'()*#+," A1EE.0"
-&2" 4&5" -$5$/<.:%.-" 4$%)" H*IJ" 9\d" $/" +HJ"
.%)&/('>"
?::.55" 60.6&0&%$(/>" R0&/1'&%$(/" %$551." &/-"
E'..-$/8" 61'6>" PZ$8>=" &/-" +V" L(:&'$M&%$(/" (<"
(/." 0((%" :&/&'>" D)." 4(0C$/8" './8%)" 4&5"
-.%.02$/.-" 4$%)" .'.:%0(/$:" &6.K" '(:&%(0" &/-"
0&-$(80&6)$:"$2&8."PZ$8"3>fV>"[/5%012./%&%$(/"
&/-"$00$8&%$(/"4$%)"H*I"J"9\d"&/-"!+J"XGD?*"
6&55$7." 1'%0&5(1/-" $00$5&<.>" G0$.-" %)." 0((%"
:&/&'" 4$%)" 5%.0$'." 6&6.0F6($/%5>" UE%10&%$(/"
"

Treatment plan
• T(/F5108$:&'" ./-(-/(%$:" %0.&%2./%*"
61'6.:%(2O"
• 9(26(5$%."0.5%(0&%$(/"-$5%&'>"
"
D)." 6&%$./%" 4$5).5" %(" C..6" %((%)" ,3*" &/-"
&::.6%" /(/F5108$:&'" ./-(-(/%$:" %0.&%2./%"
4$%)"&":(26(5$%."0.5%(0&%$(/>"
"

Problem list
• G$&8/(5$5S" $/%.0/&'" (0" :.07$:&'"
0.5(06%$(/"
• _'..-$/8"

Treatment progress "

Z$8>"3>="&/-"3>+"j"?::.55":&7$%O",;>H!>,H!3"
!I>H!>,H!3" +
• 9'$/$:&'" &/-" 0&-$(80&6)$:" .K&2$/&%$(/" ;%&1-4/&-#F+
&/-"6)(%(5>" _105*" _$(A&:.*" U/." 0((%" :&/&'S"
• G$5:155.-"%0.&%2./%"(6%$(/5>" IH^H;,=*I"22"
,;>H!>,H!3"
- Y'%0&5(1/-"[00$5&<.]"
• [/5%012./%&%$(/"(<"(/.":&/&'"
G1%)/&-#F+
" !="
 -
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After treatment

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Prognosis
Endodontic
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Tooth
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Restoration
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" /(%" 6.0<(0&%.-" %)." %((%)*" %)." %((%)" )&5" &"
Discussion
[/%.0/&'" $/<'&22&%(0O" 0((%" 0.5(06%$(/" $5" &"
0.'&%$7.'O" 0&0." 0.5(06%$(/" %)&%" E.8$/5" $/" %)."
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1/2$/.0&'$M.-" 60.-./%$/*" &66.&0" %(" <(02" &"
E&00$.0" &8&$/5%" -./%$/" 0.5(06%$(/" P!*,V>"
[/%.0/&'" 0.5(06%$(/" $5" 60.:.-.-" EO" :)0(/$:"
61'6&'" $/<'&22&%$(/*" &" -$5&66.&0&/:." (<" %)."
(-(/%(E'&5%5" &/-" 60.-./%$/*" &/-" &" 61'6&'"
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61'6(%(2O*" $/7&8$/&%$(/*" :0&:C.-" %((%)*"
%((%)" %0&/56'&/%&%$(/" &/-" (0%)(-(/%$:"
%0.&%2./%"P;V>"
D)." 60.7&'./:." (<" $/%.0/&'" 0.5(06%$(/" $5"
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%$551." 0.5(0E$/8" %)." :(0(/&'" -./%$/" &/-"
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$/%.0:(//.:%$/8":)&//.'5"PcV>"
" 4$%)" .26)&5$5" (/" %0.&%2./%"
References
!> D0(/5%&-" L*" A((%" 0.5(06%$(/" j"
.%$('(8O*" %.02$/('(8O" &/-" :'$/$:&'"
2&/$<.5%&%$(/5*" X/-(-" G./%"
D0&12&%('";"P!ccfV*"66>",;!F,I!>"
,> N.-./E.08" 9*" L$/-5C(8" `>"
XK6.0$2./%&'" $/%.0/&'" 0.5(06%$(/" $/"
2(/C.O" %..%)*" X/-(-" G./" D0&12&%('"
!"P!cfIV*"66>,,!F,,+>"
3> @$/-E(08" hh*" X-$%(0*" @&%)('(8O" (<" %.)"
-./%&'" )&0-" %$551.5*" Q1/C58&&0-"
9(6./)&8./"P!c+HV>"
;> \&&6&5&'(" Q*" X/-&'" Y>" [/%.0/&'"
$/<'&22&%(0O" 0((%" 0.5(06%$(/a" %)."
1/C/(4/" 0.5(06%$(/" (<" %.)" %((%)>"
X/-(-(/%$:"D(6$:5",HH=a"!;S"=HF+c>"
I> ?)'E.08" l*" _O5%.-%" \*" X'$&55(/" `*"
U-./0$:C" L>" L(/8" D.02" " .7&'1&%$(/" (<"
&1%(%0&/56'&/%.-" 2&K$''&0O" :&/$/.5"
4$%)" :(26'.%.-" 0((%" <(02&%$(/>" ?:%&"
U-(/%('"`:&/-"!cf3a";!S",3F3!>"
=> \.$%).05&O" R`*" 9'$/$:&'" ./-(-(/%$:"
&/-" 5108$:&'" 2&/&8.2./%" (<" %((%)"
&/-" &55(:$&%.-" E(/." 0.5(06%$(/*" [/%"
X/-(-"h"!f"P!cfIV*"66>"+,Fc,>"
+> `6q/8E.08"Lr*"\&&6&5&'("Q>"A&%$(/&'."
&/-" .<<$:&:O" (<" 0((%" :&/&'"
2&-$:&2./%5" &/-" <$''$/8" 2&%.0$&'5"
(1%:(2.>" X/-(-(/%$:" D(6$:5" ,HH,a" ,S"
3IFIf>"
f> 9&'$5C&/" Ql*" D10C1/" Q>" @0(8/(5$5" (<"
6.02&/./%" %..%)" 4$%)" $/%.0/&'"
0.5(06%$(/S" &" :'$/$:&'" 0.7$.4>" X/-(-"
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c> \.$%).05&O" R>" [/7&5$7." :.07$:&'"
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 Case 4

;'.+26.#2-"8-+-)66+2&'.--')(32-6+9),,+'7-,+2.'+,-)#*)%"'-:)23-<.#%-)#=+()#+2&%-
D)."6&%$./%*"&"!H"O.&05"('-"?5$&/"2&'."4&5"0.<.00.-"%("%)."G.6&0%2./%"(<"X/-(-(/%$:5"<0(2"61E'$:"
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"

Z$8>";>!"F""Z0(/%&'"7$.4"!!>!,>,H!,"

Chief complaint Clinical findings

T("5O26%(25" "
D((%)" 77( 73( 33(
9('-" n.5" n.5" n.5"
X@D"""HFfH" =," I3" IH"
@&'6&%$(/" T(" T(" T("
@.0:155$(/" T(" T(" T("
Q(E$'$%O" T(" T(" T("
@@G" ,"22" 3"22" ,"22"
"

Radiographic findings
" "
Z$8>",>,"j"_1::&'"&/-"6&'&%$/&'"7$.4"!!>!,>,H!,"

Medical history
T("2.-$:&'")$5%(0O"(

Dental history
Q&O",H!,"&E:.55"E1::&'"0.8$(/"0$8)%"2&K$'&0O"
'&%.0&'>" D)." 6&%$./%" 4&5" %0.&%.-" &:1%." &%" &"
61E'$:" -./%&'" :'$/$:>" ?::.55" 60.6&0&%$(/" 4&5"
-(/." &%" 0$8)%" 2&K$''&0O" '&%.0&'*" !,>" D)."
./-(-(/%$:" %0.&%2./%" 4&5" 5%&0%.-" &%" %)." " "
Z$8>";>3"&/-";>;"F"@.0$&6$:&'"0&-$(80&6)"F"!!>!,>,H!,"
61E'$:"-./%&'":'$/$:>"D)."-./%$5%":(1'-"/(%"<$/-" "

%)." (0$<$:." (<" %)." 0((%" :&/&'>" Tooth 12

9&'5$12)O-0(K$-." 4.0." 6&:C.-" $/" %)." 61'6" F [22&%10."0((%*"(6./"&6.K"
:)&2E.0"&/-"%.26(0&0O"<$''.-"4$%)"[AQ>"D)." F G./%$/FE0$-8." $/" %)." :(0(/&'" 6&0%" (<"
6&%$./%" 4.0." 0.<.00.-" %(" %)." 6(5%F80&-1&%." %)." 0((%*" &6$:&''O" <(0" %)." :.2./%("
:'$/$:"(<"./-(-(/%$:5>" ./&2.'"W1/:%$(/>"
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" Tooth 11
" F U6./"&6.K"j"$22&%10.""%((%)"
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 Tooth 21
- U6./"&6.K"j"$22&%10."%((%)"
- @?["!"

Diagnosis
@1'6&'" lHf>f" G./5" $/7&8$/&%15" %O6."
[[>"
lH;>&"T(02&'"61'6"
"
@.0$&6$:&'" lH;>E"T(02&'"&6$:&'" Z$8>";>I"j"9'$/$:&'"6)(%("(<"4)$%."QD?"6'18"!!>!,>,H!,"
6.0$(-(/%$12" "
@.0$(-(/%&'" N$%)"/(02&'"'$2$%5"
@?[" !""
"

Treatment options
• T(/F5108$:&'"./-(-(/%$:"%0.&%2./%"
• @.02&/./%"5.&'$/8"&/-"/("./-(-(/%$:"
%0.&%2./%>"

Treatment plan
• @.02&/./%" 5.&'$/8" 4$%)" QD?" :(7.0"
-./%$/E0$-8."$<"6(5$%$7."5./5$E$'$%O>" +
• ?<%.0" 3" 2(/%)5" 6.02&/./%" Z$8>";>="j"@.0$&6$:&'"0&-$(80&6)"!!>!,>,H!,"
0.5%(0&%$(/"4$%)":(26(5$%."$<"6(5$%$7." "
5./5$E$'$%O" %.5%>" [<" /.8&%$7." 5./5$E$'$%O" G1%)/&-#F+
/(/5108$:&'"./-(-(/%$:"%0.&%2./%>" • !J"T&U9'"o"!H"2'+J+!+J"XGD?"o"I"2'+
" E4'.-&-4-#+)%5/&-)%4'F+
• G-#3/")1*5.(2/5%+
Problem list <%)$(.-.*+.%3'(.-'/(4+
• 9(26'$:&%.-"0((%"2(06)('(8O" • [AQ"
" "
Second visit
Endodontic treatment Z(10" 2(/%)5" '&%.0>" T(" 5O26%(25" 5$/:." '&5%"
First visit %0.&%2./%>" 9'$/$:&'" &/-" 0&-$(80&6)$:"
9'$/$:&'" &/-" 0&-$(80&6)$:" .K&2$/&%$(/" &/-" .K&2$/&%$(/" 4&5" -(/.*" %(" 5.." $<" %)." %((%)"
6)(%(>" N&5" :&00$.-" (1%" ?/.5%).5$&" !" K" 4&5"5%$''"6(5$%$7."5./5$%$7$%O>"D).".'.:%0$:"61'6"
`.6%(:&$/.]>" A1EE.0" -&2" 4&5" -$5$/<.:%.-" %.5%"PX@DV"5)(4.-"I3"PHFfHV"&/-"0.56(/5."(/"
4$%)""H*IJ"9\d"$/"+HJ".%)&/('>"D)."[AQ"4&5" %)."X/-("$:."5)(4.-"6(5$%$7.>""D)."6.0$&6$:&'"
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" Tooth
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+HJ" .%)&/('>" D)." [AQ" 4&5" 0.2(7.->" Restoration
[00$8&%$(/" 4$%)" !" J" T&U9'" &/-" !+" J" XGD?>" - Z&7(0&E'."
Y'%0&5(1/-" $00$5&<.]>" @&:C.-" [AQ" &/-" %)./" Control - after 1 year
9(26(5$%.-!3+J"6)(56)(0$:"&:$-*"5:(%:)E(/-" "
3Q"60$2.0"&/-"&-).5$7.*"rF,IH"?3"P3QV>"
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• !J"T&U9'"o"!H"2'+J+!+J"XGD?"o"I"2'+
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Z$8>" ;>f" j" 9'$/$:&'" 6)(%(80&68O" j" !" O.&0" <(''(4F16"
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Before treatment
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Z$8>" ;>c" j" @.0$&6$:&'" 0&-$(80&6)" j" !" O.&0" <(''(4" 16"
H,>H;>,H!;"
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After treatment ?%"%)."(/."O.&0"<(''(4"16"%)."%((%)"!,"4.0."
" -$5:('(0.-*" 80.O" :('(0*" 6(5$%$7." 5./5$E$'$%O" &%"
%)."%.5%5"4$%)"./-("$:."&/-"X@D"II"PHFfHV*"/("
5O26%(25"%("6.0:155$(/"(0"6&'6&%$(/>"
@.0$&6$:&'" 0&-$(80&6)" -.2(/5%0&%.-"
&6.C5(8./.5.5":(/%$/1.->"
"

Discussion
G./5" $/7&8$/&%15" $5" &" 0&0." 2&'<(02&%$(/" (<"
%..%)*" 5)(4$/8" &" E0(&-" 56.:%012" (<"
2(06)('(8$:&'" 7&0$&%$(/5>" D)." &<<.:%.-" %..%)"
0&-$(80&6)$:&''O"5)(4"&/"$/<('-$/8"(<"./&2.'"
&/-"-./%$/."4)$:)"2&O".K%./-"-..6"$/%("%)."
61'6":&7$%O"&/-"$/%("%)."0((%"&/-"5(2.%$2.5"
.7./"0.&:)"%)."0((%"&6.K"P!V"
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Prognosis 2&'<(02&%$(/" $5" :(/%0(7.05$&'" &/-" 0.2&$/5"
Endodontic 1/:'.&0>" `.7.0&'" %).(0$.5" )&7." E../"
- Z&7(0&E'." 60(6(5.-" %(" .K6'&$/" %)." &.%$('(8O" (<" -./%&'"
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0('.5" 51:)" &5" %)." 0.81'&%$(/" (<" 80(4%)" &/-" D)." %..%)" 2(5%" &<<.:%.-" &0." 2&K$''&O" '&%.0&'"
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(<":.0%&$/"2('.:1'.5":&/"0.51'%"$/"&E/(02&'O" 1/:(22(/"&/-"(::105"$/";3J"(<"&''":&5.5"P;V>"
5)&6.-" %..%)" &5" 4.''" &5" -.<.:%5" $/" %)." `.7.0&'" 0.6(0%5" (/" 2$:0(5:(6$:*"
-.7.'(6$/8" %((%)" 8.02" P+V>" Z(0" %)$5" 0.&5(/" 1'%0&5%01:%10&'" &/-" 2$:0(0&-$(80&6)$:"
%)."60(6(5&'"%)&%"8./.%$:"<&:%(05"2&O"E."%)." $/7.5%$8&%$(/5" (<" %..%)" 4$%)" &" -./5"
:&15." (<" -./5" $/7&8$/&%15" )&5" 5(2." $/7&8$/&%15" 5)(4" &" 4$-." 0&/8." (<" <$/-$/85"
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&/-"-.5:0$E.-"%)."&/(2&'O"(::10$/8"$/"%)0.." $/7&8$/&%$(/" 2&O" E." $/%&:%" 4$%)(1%"
<(025S" $00.81'&0$%$.5*"E1%"&'5("2&O":(/%&$/"5%0&$/5"(<"
DO6."[S"&/"./&2.'F'$/.-"2$/(0"<(02"(::10$/8" 7$%&'" :(//.:%$7." %$551." (0" .7./" <$/." :&/&'5"
4$%)$/" %)." :(/<$/.5" (<" %)." :0(4/" /(%" 4$%)" :(221/$:&%$(/" %(" %)." -./%&'" 61'6>"
.K%./-$/8" E.O(/-" %)." &2.'(:.2./%&'" `(2." &1%)(05" 0.6(0%.-" )O6(2$/.0&'$M.-" (0"
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DO6." [[S" &/" ./&2.'F'$/.-" <(02" 4)$:)" $/7&-.5" D)." 5%01:%10." &/-" %)$:C/.55" (<" %)." ./&2.'"
%)."0((%"E1%"0.2&$/5":(/<$/.-"&5"&"E'$/-"5&:>" )&7."E../"-.5:0$E.-"&5"$00.81'&0'O"5%01:%10.-"
[%" 2&O" (0" 2&O" /(%" :(221/$:&%." 4$%)" %)." &/-" )O6(2$/.0&'$M.-" &%" %)." E&5." (<" %)."
-./%&'"61'6>" $/7&8$/&%$(/"P!V>"
DO6."[[[S"&"<(02"4)$:)"6./.%0&%.5"%)0(18)"%)." D)."$/7&8$/&%$(/"&''(45"./%0O"(<"$00$%&/%5"$/%("
0((%"6.0<(0&%$/8"&%"%)."&6$:&'"&0.&"5)(4$/8"&" &/"&0.&"4)$:)"$5"5.6&0&%.-"<0(2"61'6&'"%$551."
5.:(/-" <(0&2./" $/" %)." &6$:&'" (0" $/" %)." EO" (/'O" &" %)$/" '&O.0" (<" ./&2.'" &/-" -./%$/."
6.0$(-(/%&'" &0.&>" D).0." $5" /(" $22.-$&%." &/-" 60.5./%5" &" 60.-$56(5$%$(/" <(0" %)."
:(221/$:&%$(/" 4$%)" %)." 61'6>" D)." -.7.'(62./%" (<" -./%&'" :&0$.5>" [/" 5(2." :&5.5"
$/7.8$/&%$(/" 2&O" E." :(26'.%.'O" '$/.-" EO" %)." ./&2.'F'$/$/8" $5" $/:(26'.%.*" &/-" &'5("
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<(1/-"'$/$/8"%)."$/7&8$/&%$(/>"
Dens invaginatus 81
&/-" %)." 61'6>" D).0<(0" 61'6" /.:0(5$5" (<%./"
" (::105" 0&%).0" .&0'O*" 4$%)$/" &" <.4" O.&05" (<"
s malformation is .016%$(/*" 5(2.%$2.5" .7./" E.<(0." 0((%" ./-"
ver the last decades
ed to explain the :'(510."P!V>"
ons: "
results in buckling
Atkinson 1943). [/"%)$5":&5."%)."-$&8/(5$5"(<""$22&%10."%((%)"
the invagination
wth of the internal
!," 4&5" -./5" $/7&8$/&%15" %O6." [[" PU.)'.05"
rrounding normal 9'&55$<$:&%$(/5v5V"4$%)"&"7$%&'"61'6>"D).0"4.0."
te and engulfs the
%4("8(&'5"(<"%0.&%2./%"$/"%)$5":&5.a""
e invagination is a " - 2&C." &" E&00$.0" %(4&0-" %)." 61'6*" $<"
feration of a part of Z$8>"!"9'&55$<$:&%$(/"(<"$/7&8$/&%.-"%..%)"EO"U.)'.05>"
Fig. 3 Classification of invaginated teeth by Oehlers (1957).
%).0."4.0."/(":(21/$:&%$(/"E.%4../""
nvading the dental
"
nign neoplasma of
the confines of the crown not extending -./5"$/7&8$/%15"&/-"%)."61'6>""
Y5$/8" U.)'.05v9'&55$<$:&%$(/5*" %)." 60.7&'./:."
at distortion of the
beyond the amelocemental junction.
- 2&$/%&$/"%)."&6.K(8./.5."
(<".&:)"%O6."(<"$/7&8$/&%$(/"4&5"0.6(0%.-"P=V"
Type II: an enamel-lined form which invades the root
opment and subse-
but remains confined as a blind sac. It may or N.":)((5.-"%("15."4)$%."QD?"&5"&"E&00$.0>""
enamel organ will 4$%)"DO6."["E.$/8"2(5%":(22(/"P+cJV"4)$'5%"
may not communicate with the dental pulp.
mel-lined channel "
nally at the incisal DO6."
Type III: [[" P!IJV"
a form &/-" [[["through
which penetrates PIJV" the '.55"
root per-<0.B1./%'O"
forating at the apical area showing a ‘second QD?" 4&5" 5)(4/" %(" )&7." 8((-" 5.&'$/8"
ted with irregular (E5.07.->" U.)'.05v5O5%.2"
foramen’ $5"periodontal
in the apical or in the E&5.-" (/" &" %4("
:&6&E$'$%O"Pf*cV*"E$(:(26&%$E$'$%O"P!HV"&/-"'&:C"
uggested a fusion of -$2./5$(/&'" 0&-$(80&6)$:" $2&8." &/-" &5" 51:)"
area. There is no immediate communication
with the pulp. The invagination may be com- (<"5('1E$'$%O"$/"4&%.0"P!!V>"N)./"61'6":&66$/8"
2&O" 1/-.0.5%$2&%.%" %)."
pletely lined by enamel, but %01."
frequently .K%./-" &/-"
cemen-
esponsible for the
tum will be found lining the invagination. 60(:.-10.5" 4.0." :(/-1:%.-" 15$/8" QD?" $/"
6) and Sprawson :(26'.K$%O"(<"%)."$/7&8$/&%$(/"P+V"
Oehlers (1957a,b) also described different crown forms
(normal with a deep lingual or palatal pit; conical,
cussed trauma as a
sufficiently explain ,3"
barrel-shaped or peg-shaped with an incisal pit) relating "
to the three groups mentioned above. In addition,
s were affected and
Ulmansky & Hermel (1964) and Vincent-Townend
(1974) described an ‘incipient dens in dente’, a deep
ens invaginatus as
palatal or lingual pit completely lined by enamel with no
%..%)" (<" 2(/C.O5" &''" 61'65" 5)(4.-" -./%$/"
E0$-8."<(02&%$(/"&<%.0"I"2(/%)5"P!,V>"
`%1-O"5)(45"%..%)"-$5:('(0.-"4)./"0.5%(0.-"
4)$%"4QD?*"&/-"%)&%"4QD?"$/-1:.5"%)."80&O"
-$5:('(0&%$(/" (<" %)." %((%)" :0(4/*" &/-" %)."
.<<.:%" $5" :(26(1/-.-" $/" %)." 60.5./:." (<"
E'((-"P!3V"
" DA>"`.&'$/8"&E$'$%O"(<"&"2$/.0&'"%0$(K$-."
?%" %)." (/." O.&0" <(''(4" 16" .K&2$/&%$(/5" %)."
%((%)" !," )&-" E../" -$5:('(10.-" 4$%)" &" 80.O"
:('(10>" D)$5" (1%:(2.5" $5" &" -$5&-7./%&8." (<"
QD?>"
D)."6&%$./%"(0"%)."6&0./%5"4.0."/(%"&<<.:%.-"
4$%)"-$5:('(0&%$(/>"
References
!> \w'52&//" Q>" G./5" $/7&8$/&%15S"
&.%$('(8O*" :'&55$<$:&%$(/*" 60.7&'./:.*"
-$&8/(5$5" &/-" %0.&%2./%"
:(/5$-.0&%$(/5>" A.7$.4>" [/%.0/&%$(/&'"
X/-(-(/%$:"h(10/&'"!cc+a"3Ha"+cFcH>"
,> U.)'.05" Z?>" G./5" $/7&8$/&%15>" [>"
#&0$&%$(/5"(<"%)."$/7&8$/&%$(/"60(:.55"
&/-" &55(:$&%.-" &/%.0$(0" :0(4/" <(025>"
U0&'" `108.0O*" U0&'" Q.-$:$/." &/-" U0&'"
@&%)('(8O"!cI+&a"!H*"!,H;F!f>"
3> U.)'.05" Z?>" G./5" $/7&8$/&%15" [[>"
?55(:$&%.-"6(5%.0$(0":0(4/"<(025"&/-"
6&%)(8./.5$5>" U0&'" `108.0O*" U0&'"
Q.-$:$/." &/-" U0&'" 6&%)('(8O" !cI+Ea"
!Ha"!3H,F!=>"
;> R0&)/./"\*"L$/-&)'"_*"U2/.''"l>"G./5"
$/7&8$/&%15" [*" ?" :'$/$:&'*"
0(./%8./('(8$:&'" &/-" 8./.%$:&'" 5%1-O" "
(<" 6.02&/./%" 166.0" '&%.0&'" $/:$5(05>" "
U-(/%('(8$5C"0.7O"!cIca"!Ha"!!IF3+>" "
I> _&:C2&/" _*" N&)'$/" n_>" #&0$&%$(/5" $/" "
/12E.0" &/-" 2(06)('(8O" (<" "
6.02&/./%" %..%)" $/" +FO.&0F('-" "
`4.-$5)" :)$'-0./>" [/%.0/&%$(/&'" "
h(10/&'" (<" @.-$&%0$:" G./%$5%0O" ,HH!a" "
!!a"!!F+>" "
=> A$-.''" " l*" Q.Wx0." [*" Q&%55(/" L>" G./5" "
$/7&8$/&%15S" &" 0.%0(56.:%$7." 5%1-O" (<"
60(6)O'&:%$:" $/7&8$/&%$(/" %0.&%2./%>"
" "
" "
" "
" "
" "
"
[/%.0/&%$(/&'" h(10/&'" (<" @&.-$&%0$:"
G./%$5%0O",HH!a"!!a"c,F+>"
+> ?'&/$" ?*" _$5)(6" l>" G./5" $/7&8$/&%15>"
@&0%" !S" :'&55$<$:&%$(/*" 60.7&'./:." &/-"
&.%$('(8O>" [/%.0/&%$(/&'" X/-(-(/%$:"
h(10/&'",HHfa";!a"!!,3F!!3=>"
f> D(0&E$/.W&-" Q*" N&%5(/" DZ*" @$%%" Z(0-"
&880.8&%." 4)./" 15.-" &5" &" 0((%" ./-"
<$''$/8" 2&%.0$&'>" h" X/-(-(/" !cc3a" !ca"
Ic!FI>"
c> D(0&E$/.W&-"Q*"A&5%.8&0"?Z*"l.%%.0$/8"
hG*" @$%%" Z(0-" DA>" _&:%.0$&'" '.&C&8." (<"
2$/.0&'" %0$(K$-." &880.8&%." &5" &" 0((%F
./-" <$''$/8" 2&%.0$&'>" h" X/-(-/" !ccIa"
,!S"!HcF!,>"
!H> D(0&E$/.W&-"Q*"\(/8"9Y*"6$%%"Z(0-"DA*"
l.%%.0$/8"hG>"9O%(%(K$:$%O"(<"<(10"0((%"
./-" <$''$/8" 2&%.0$&'5>" h" X/-(-(/"
!ccIy*",!a";fcFc,>"
!!> D(0&E$/.W&-"Q*"\(/8"9Y*"Q:G(/&'-"Z*"
@$%%" Z(0-" DA*" @)O5$:&'" &/-" :).2$:&'"
60(6.0%$.5" (<" &" /.4" 0((%F./-" <$''$/8"
2&%.0$&'>"h"X/-(-(/"!ccIa",!a"3;cFI3>"
!,> @$%%" Z(0-" DA*" D(0&E$/.W&-" Q*" ?E.-$"
\A*" _&C'&/-" Ll*" l&0$O&4&5&2" `@>"
Y5$/8" 2$/.0&'" %0$(K$-." &880.&8%." &5" &"
61'6F:&66$/8" 2&%.0$&'>" h" ?Q" G./%"
?55(:"!cc=a"!,+a"!;c!F;>"
!3> G&/$.'" Z.'2&/*" @.%.0" @&0&5)(5>"
9(0(/&'"%((%)"-$5:('(0&%$(/"&/-"4)$%."
2$/.0&'"%0$(K$-."&880.8&%.>"h(10/&'"(<"
X/-(-(/",H!3a"3c>"
" ,;"
 Case 5

>#<"<"#2)*-2'.+26.#2-"8-')(32-6+#<)?&,+'-,+2.'+,-)#*)%"'-:)23-+5)*+,-5.')"<"#2)2)%-
D)."6&%$./%*"&"I3"O.&0"('-"7.5%"?5$&/"2&'.*"4&5"0.<.00.-"%("%)."G.6&0%2./%"(<"X/-(-(/%$:5"<0(2"
%)."G.6&0%2./%"(<"@.0$(-(/%('(8O"&%"%)."Y/$7.05$%O"(<"U5'(*"<(0".7&'1&%$(/"&/-"./-(-(/%$:"
%0.&%2./%"(<"%)."0$8)%"2&/-$E1'&0"'&%.0&'"$/:$5(0*";,>"
"

Z$8>"I>!"F""Z0(/%&'"7$.4"3H>H3>,H!!"
"

Chief complaint Clinical findings

T(" 5O26%(25" E1%" %)." 6&%$./%" 4&5" 0.<.00.-" "
<(0"./-(-(/%$:"%0.&%2./%"(<"%((%)";,"" D((%)" ;7( ;3( ;<(
" 9('-" n.5" T(" n.5"
X@D"""HFfH" c" fH" 3!"
@&'6&%$(/" T(" T(" T("
@.0:155$(/" T(" T(" T("
Q(E$'$%O" n.5" n.5" n.5"
80&-."!" 80&-."!" 80&-."!"
" @@G" ;"22" ;"22" ;"22"

Radiographic findings
"

"
Z$8>"I>,"&/-"I>3"F"U::'15&'"&/-"'$/81&'"7$.4"3H>H3>,H!!"

Medical history
T("

Dental history
• @0.7$(15'O"%0&12&"
• G.:&'5$<$:&%$(/^"G./%&'"Z'1(0(5$5" " "
Z$8>"I>;"&/-"I>I"F"@.0$&6$:&'"0&-$(80&6)"F"3H>H3>,H!!"
• ?%%0$%$(/" "
• 9)0(/$:"2&08$/&'"6.0$(-(/%$%$5"" Tooth 41
F A.-1:.-"E(/."&%%&:)2./%"z,^3"
" F ?%%0$%$(/"
" F ?6$:&'"0&-$('1:./:O"
" F @?[";"" "
Tooth 42
"
F A.-1:.-"E(/."&%%&:)2./%"z,^3"
"
F ?%%0$%$(/"
"
,I" "
 F ?6$:&'"0&-$('1:./:O" %&C./" PZ$8>" I>=V>" " N(0C$/8" './8%)" 4&5"
F @?[;" :(/<$02.-" 4$%)" &/" &6.K" '(:&%(0" PA((%" !rdV>"
Tooth 43 D)." 0((%" :&/&'5" 4./%" %(8.%).0" %(" (/." &6$:&'"
F L(/8"0((%" <(0&2./>"D)."0((%":&/&'5"4.0."$/5%012./%.-"
F A.-1:.-"E(/."&%%&:)2./%"{" %(" 5$M." ;HH;" ^" ,," 22" 4$%)" _$(0&:.>" G10$/8"
F D)." '&2$/&" -10&" :&/" E." <(''(4.-" $/5%012./%&%$(/" %)." :&/&'" 4&5" %)(0(18)'O"
4$%)(1%"-$5016%$(/" $00$8&%.-"4$%)"!J"T&U9'"&/-"!+J"XGD?"EO"&$-"
(<" 1'%0&5(1/-" $00$5&<.!>" D)." 0((%" :&/&'" 4.0."
Diagnosis
-0$.-" 4$%)" 5%.0$'." 6&6.0" 6($/%5" &/-" 6&:C.-"
@1'6&'" lH;>!"T.:0(%$:"
4$%)" :&':$12" )O-0(K$-.>" D)." &::.55" :&7$%O"
@.0$&6$:&'" lH;>I"9)0(/$:"&6$:&'"
4&5" 5.&'.-" 4$%)" %.26(0&0O" <$''$/8" 9&7$%" &/-"
6.0$(-(/%$%$5"
[AQ>"
@.0$(-(/%&'" lHI>3" 9)0(/$:" 2&08$/&'"
"
6.0$(-(/%$%$5"
@?[" ;"

Treatment options
• T(/"5108$:&'"./-(-(/%$:"%0.&%2.%/"
• XK%0&:%$(/"

Treatment plan 30.03.2011

• T(/F5108$:&'"./-(-(/%$:"%0.&%2./%"
• 9(26(5$%.""

Problem list
• ?/&%(2Oa"<$/-"%).":&/&'P5V"

Treatment progress
3H>H3>,H!!" "
• 9'$/$:&'"&/-"0&-$(80&6)$:".K&2$/&%$(/>" Z$8>"I>="j"N(0C$/8"'./8%)"0&-$(80&6)"H;>HI>,H!!"
• G$5:155.-"%0.&%2./%"(6%$(/5>" "
H;>HI>,H!!" ;%&1-4/&-#F+
• [/5%012./%&%$(/" - _105*"lF<'.K"<$'.5*"_$(0&:."
3!>HI>,H!!" |H;H^>H;"j",,"22"
• UE%10&%$(/" - [00$5&<.]"
• 9(26(5$%." G1%)/&-#F+
HI>H,>,H!3" - !J"T&U9'"o"!H"2'+J+!+J"XGD?"o"I"2'+
• 9(/%0('" - @&55$7."1'%0&5(/$:"$00$8&%$(/*""
E4'.-&-4-#+)%5/&-)%4'F+
Endodontic treatment - 9&PU\V,"
First visit
<%)$(.-.*+,/##/40F+
9'$/$:&'" &/-" 0&-$(80&6)$:" .K&2$/&%$(/" 4&5"
- 9&7$%"&/-"[AQ>"
:&00$.-" (1%>" D)." 6&%$./%" 4&/%5" %(" C..6" %)."
"
%((%)" &/-" &::.6%" %)." ./-(-(/%$:" %0.&%2./%>" Third visit
?::.55" 60.6&0&%$(/>" X18./('" 6.''.%" &/-" T("5O26%(25"5$/:."'&5%"%0.&%2./%>"
%.26(0&0O"<$''$/8"[AQ>"" "
" A1EE.0" -&2" 4&5" -$5$/<.:%.-" 4$%)" H*IJ" 9\d"
Second visit
$/" +HJ" .%)&/('>" D.26(0&0O" <$''$/8" [AQ" 4&5"
A1EE.0" -&2" 4&5" -$5$/<.:%.-" 4$%)" H*IJ" 9\d"
0.2(7.-" &/-" %)." :&/&'" $00$8&%.-" 4$%)" !" J"
$/" +HJ" .%)&/('>" D)." %.26(0&0O" <$''$/8" [AQ"
T&U9'" &/-" !+" J" XGD?" 4$%)" 1'%0&5(/$:"
4&5"0.2(7.->","0((%":&/&'5"'(:&'$M.->"D4("lF
&:%$7&%$(/>" Q&5%.0F:(/." 0&-$(80&6)" 4&5"
<'.K" /0" !I" ^" ,," 22" <$'.5" 4&5" $/5.0%.-" $/" %)."
%&C./>" PZ$8" I>+V" D)." :&/&'" 4&5" -0$.-" 4$%)"
:&/&'" &/-" 4(0C$/8" './8%)" 0&-$(80&6)" 4&5"
" ,="
5%.0$'." 6&6.0" 6($/%5" &/-" <$''.-" 4$%)" ?\" 6'15" Before treatment
&/-" 81%%&F6.0:)&" 4$%)" :('-" '&%.0&'" "
:(/-./5&%$(/"%.:)/$B1."PZ$8"I>fV>"D)."&::.55"
:&7$%O" 4&5" 5.&'.-" 4$%)" %.26(0&0O" <$''$/8" [AQ"
&/-"6.02&/./%"<$''$/8"4$%)":(26(5$%."
G1%)/&-#F+
- !J"T&U9'"o"!H"2'+J+!+J"XGD?"o"I"2'+
- Y'%0&5(1/-"$00$5&<.]+
KA'".-'/(4+
•
R1%%&F6.0:)&"&/-"?\"@'15](
!%.)-4%4'+.%3'(.-'/(4+
• D.26(0&0O"<$''$/8"[AQ+
• 9(26(5$%.+
"

"
"

After treatment
"

"
Z$8>"I>+"j"Q&5%.0F6($/%"0&-$(80&6)"I>HI>,H!!"
"

"
Prognosis
Endodontic
- Z&7(0&E'."
Tooth
- Y/:.0%&$/"
Restoration
- Z&7(0&E'."

Evaluation
D)." %0.&%2./%" (<" %((%)" ;," 4&5"
" 1/:(26'$:&%.-" &/-" &66.&0" %.:)/$:&''O"
Z$8>"I>f"j"Z$/&'"0&-$(80&6)"I>HI>,H!!"
5&%$5<&:%(0O"(/"%)."0&-$(80&6)5>"

"
"
"
"
,+" "
 Control - after 2 year
" the body of the root. T
" absolute prerequisites for evaluating color changes and
Z$8>"I>c"F"@.0$&6$:&'"0&-$(80&6)"j"%4("O.&05"<(''(4"16"
HI>H,>,H!3"
" [/-$&" $/C*" -.:&':$<$.-*" &/-" :'.&0.->" D)."
?%" %)." %4(" O.&0" :(/%0('" %)." 6&%$./%" )&-" /("
5O26%)(25>" T(02&'" (0&'" 21:(5&" 4&5"
(E5.07.->" @0(E$/8" -.6%)5" 4.0." 4$%)$/"
/(02&'" '$2$%5>" T(" 6&$/" %(" 6.0:155$(/" (0" %("
6&'6&%$(/" :(1'-" E." <(1/->" A&-$(80&6)"
5)(4.-".7$-./:."(<").&'$/8"(<"%)."6.0$&6$:&'"
0&-$('1:./:O";,>""
" An examination of the floor of the pulp chamber
Discussion
?" -.%&$'.-" C/(4'.-8." (<" %)." /12E.0" (<" %)."
0((%" :&/&'" 5O5%.25" &/-" :0(55F5.:%$(/"
2(06)('(8O" $5" 0.B1$0.-" <(0" 51::.55<1'" 0((%"
:&/&'" %0.&%2./%>" P!V>" Z&$'10." %(" &:)$.7."
:(26'.%." :'.&/$/8" (<" %)." 2&$/" 0((%" :&/&'5"
&/-"'&%.0&'"&/&%(2O":&/"'.&-"%("%)."<&$'10."(<"
%)." ./-(-(/%$:" %0.&%2./%" E.:&15." (<" %)."
C/(4/" $/<.:%$(15" .%$('(O" (<" &6$:&'"
6.0$(-(/%$%$5>"
A((%" :&/&'" 5O5%.25" &0." .7&'1&%.-" &<%.0"
0.2(7$/8" %)." 61'6" :).2$:&''O" .$%).0" EO"
6126$/8" 2&%.0$&'5" $/%(" %)$5" 56&:." 4$%)"
60.5510." 4)$:)" <(0:.5" %)." 2&%.0$&'" %(" %&C."
%)."5)&6."(<"%)."56&:.*"EO"%&C$/8"'(/8$%1-$/&'"
5.:%$(/5" <0(2" %)." %..%)*" EO" 0&-$(80&6)$:"
%.:)/$B1.5*"(0"EO":'.&0$/8"%)."%..%)"P;F=V>"
#.0%1::$" :'&55$<$.-" &/-" -.5:0$E.-" %)." 0((%"
:&/&'" 5O5%.25" (<" )12&/" 6.02&/./%" %..%)"
$/%(".$8)%"-$<<.0./%"%O6.5"P!V"
"
significant. The closer the
the chance that the two c
upon introduction into a
the initial file placed
mandibular molar for e
buccal or lingual, one sho
two canals are present eac
canal.
Whenever a root conta
palatal/lingual canal is g
line access to the apex. T
preparing and obturatin
" the apex and the buccal
G$&80&22&%$:"
Fig. 8. Diagrammatic 0.60.5./%&%$(/" (<" #.0%1::$v5"
representation of Vertucci’s canal (90).:&/&'"
If both canals are e
:(/<$810&%$(/5"P,V>"
configurations. glass’ preparation results
"helpful to do so before placing the dental dam. This
canals join would be
preparation at the apex.
l&0%&'" .%" &'" $/7.5%$8&%.-" !HH" 2&/-$E1'&0"
enables the dentist to evaluate root relationships and voids in the apical third a
:./%0&'" &/-" '&%.0&'" $/:$5(05" %(" -.%.02$/." %)."
work more effectively in the long axis of the tooth.
However, once the canal is located, the dental dam must
bacteria remain in the can
must also be used with
/12E.0" (<" 0((%" :&/&'5" &/-" %).$0" %O6.5*" %)."
be placed before proceeding further. When searching anatomy is present becau
0&2$<$:&%$(/5" (<" %)." 0((%" :&/&'*" %)." '(:&%$(/"
for a calcified canal, magnification and illumination are occur as the file transvers
common part of the can
(<" &6$:&'" <(0&2$/&*" &/-" %)." <0.B1./:O" (<"
working deep inside the tooth. It is also helpful to into two, the division is
&6$:&'" -.'%&5>" D)." %..%)" 4.0." $22.05.-" $/"
occasionally stop and take additional radiographic lingual canal generally sp
views. The straight facial radiograph provides informa- sharp angle; sometimes a
tion about the mesial-distal penetration while an angled Slowey (91) recommend
.K&2$/&%$(/" (<" 0((%" :&/&'" 5O5%.25" (<" %)."
radiograph provides information about the facial- this canal configuration
lingual penetration. These radiographs help determine
%..%)" 4&5" E&5.-" (/" #.0%1::$5" :'&55$<$:&%$(/>"
the correctness of the penetration angle and its
buccal canal would be th
letter ‘h’ whereas the lin
D)$5"5%1-O*"%)."$/:$-./:."(<"%)."60.5./:."(<"&"
proximity to the elusive canal. The LN bur (Caulk/ root at a sharp angle fro
Dentsply, Tulsa, OK, USA), the Mueller bur (Brasseler,
5.:(/-":&/&'"4&5"<(1/-"%("E.";IJ*"&/-"%4("
Savannah, GA, USA) and thin ultrasonic tips are
This necessitates a mod
lingual in order to achi
:&/&'5":(//.:%"$/"%)."&6$:&'"%)$0-"3+J"(<"%)."
especially useful for locating calcified root canals. instruments into the ling
Locating canals and initial penetration under the micro-
%$2."&/-"0.&:)"%)."&6.K"&5"(/.":&/&'"P3V>"
scope is aided by fine instrument like the Micro-Orifice
Maxillary molars gener
have as many as three m
_./W&2$/" &/-" G(45(/" 0.6(0%.-" %)&%" %)."
Opener (Dentsply Maillefer, Ballaigues, Switzerland). and two palatal canals.
$/:$-./:." (<" %)." 60.5./:." (<" &" 5.:(/-" :&/&'"
maxillary first molar has
offers clues to the location of orifices and to the type of clinical investigation tha
$/" 2&/-$E1'&0" $/:$5(05" 4&5" ;!*;" J" P;V*"
canal system present. When there is only one canal, it is generally has two canals
usually located in the center of the access preparation.
Q&-.$0&"&/-"\.%.2"!!*I"J"P+V*"#.0%1::$",I*+" reported. When there
All such orifices particularly if oval in shape must be mesiobuccal (MB-1) an
J"PfV*"R0../",H"J"PcV"
thoroughly explored with apically precurved small K- 2). Görduysus et al. (7
[/"%)."60.5./%":&5."%)."2&/-$E1'&0";,")&-"&"
type files to determine if more than one canal is present. pathway of the MB-2 can
If only one orifices is found that is not in the center of molars using the DOM a
%O6."[[["P!F,F!V"$/"#.0%1::$v5":'&55$<$:&%$(/5>"
the preparation, it is probable that another is present this canal varies greatly
"and one should be searched for on the opposite side. mesial to or directly on
The relationship of the two orifices to each other is also the palatal orifices (Fig.
A&-$(80&6)5" 2&O" /(%" &'4&O5" -.%.02$/." %)."
:(00.:%" 2(06)('(8O" 6&0%$:1'&0'O" 4)./" (/'O" &"
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P!HV" 0&-$(80&6).-" ;II" .K%0&:%.-" 2&/-$E1'&0"
$/:$5(0"%("&55.55"%)."$/:$-./:."(<"%4$/":&/&'5"
&5" 7$51&'$M.-" (/" 0&-$(80&6)5" %&C./" $/" %)."
2.5$(F-$5%&'" -$0.:%$(/>" D).O" :(/:'1-.-" 4$%)"
%)." &55.552./%" (<" &" 5$/8'." 0&-$(80&6)" %&C./"
$/"%)."E1::(F'$/81&'"7$.4*"15$/8"%)."81$-.'$/."
%)&%" -$5&66.&0&/:." (0" /&00(4$/8" $/<.05"
-$7$5$(/*"0.51'%.-"$/"&"<&$'10."%("-$&8/(5."(/.F
%)$0-" (<" %4$/" :&/&'5>" [%" $5" %).0.<(0" $26(0%&/%"
%)&%" %)." (6.0&%10." 5)(1'-" &'5(" &55.55"
:'$/$:&''O"%).":&/&'"2(06)('(8O"(<".&:)"%((%)"
%(" E." %0.&%.-" &/-" 0&-$(80&6)$:" -$&8/(5$5"
5)(1'-"E."0.8&0-.-"&5"&/"&$-"%("-$&8/(5$5>"
"
" ,f"
[/" %)$5" :&5." [" %)$/C" $%" 4&5" 7.0O" -$<<$:1'%" %("
7$51&'$5." &%" %)." 0&-$(80&6)*" %)." %4$/" :&/&'5"
&::(0-$/8" %(" #.0%1::$v5" :'&55$<$:&%$(/" %O6." [[["
P!F,F!V>" X7./" %)." 0&-$(80&6)" 4.0." %&C./" $/"
-$<<.0/.%"&/81'&%$(/>"
" 2(06)('(8O" (<" 2&/-$E1'&0" <$05%" &/-"
References
!> #.0%1::$" Zh>" A((%" :&/&'" &/&%(2O" (<"
%)." )12&/" 6.02&/./%" %..%)>" U0&'"
`108" U0&'" Q.-" U0&'" @&%)('" !cf;a" I3S"
IfcFcc>"
,> #.0%1::$" Zh>" A((%" :&/&'" 2(06)('(8O"
&/-" $%5" 0.'&%$(/5)$6" %(" ./-(-(/%$:"
60(:.-10.5>" X/-(-(/%$:" D(6$:5" ,HHI*"
!H*"3F,c>"
3> l&0%&'" T*" n&/$C(8'1" Z9>" A((%" :&/&'"
2(06)('(8O" (<" 2&/-$E1'&0" $/:$5(05>"
h(10/&'"(<"X/-(-(/%$:5"!cc,a"!fa"!!"
;> _./W&2$/" l?*" G&45(/" h>" [/:$-./:." (<"
%4("0((%":&/&'5"$/")12&/"2&/-$E1'&0"
$/:$5(0"%..%)>"U0&'"`108"!c+;a"3fS"!,,F
=>"
I> \&55.'80./" R*" T.''.5%&2" @*" _O/12F
\&55.'80./" AQ>" D..%)" 4$%)"
"
"
"
"
"
"
,c"
%0&/56&0./%" 0((%5" j" ?/" $260(7.-"
%.&:)$/8" &$-" <(0" 60.:'$/$:&'"
./-(-(/%$:5>" h" X/-(-(/" !cf+a" !3S"
!,=F+>"
=> r$''$:)" A*" G&45(/" h>" A((%" :&/&'"
5.:(/-"60.2('&05>"U0&'"`108"!c+3a"3=S"
+3fF;;>"
+> Q&-.$0&" Q*" \.%.2" `>" [/:$-./:." (<"
E$<10:&%$(/5" $/" 2&/-$E1'&0" $/:$5(05>"
U0&'"`108"!c+3a"3=S"IfcFc!>"
f> #.0%1::$"ZWS"A((%":&/&'"&/&%(2O"(<"%.)"
2&/-$E1'&0"&/%.0$(0"%..%)>"h"?2"G./%"
?55(:"!c+;a"fcS"3=cF+!>"
c> R0../" G>" ?" 5%.0.(2$:0(5:(6$:" 5%1-O"
(<" %)." 0((%" &6$:.5" (<" ;HH" 2&K$''&0O"
&/-" 2&/-$E1'&0" &/%.0$(0" %..%)>" U0&'"
`108"!cI=a"c!S"!,,;Ff>"
!H> T&%%0.55"_A*"Q&0%$/"GQ>"@0.-$:%&E$'$%O"
(<"0&-$(80&6)$:"-$&8/(5$5"(<"7&0$&%$(/5"
$/" 0((%" :&/&'" &/&%(2O" $/" 2&/-$E1'&0"
$/:$5(0" &/-" 60.2('&0" %..%)>" [/%"
X/-((-" h" !cc!S" ,;S" IfF=,>
"
 Case 6

>#<"<"#2)*-2'.+26.#2-"8-+-')(32-6+9),,+'7-8)'%2-6",+'-:)23-+5)*+,-5.')"<"#2)2)%-+#<-
+**)<.#2+,-8&'*+2)"#-5.'8"'+2)"#@
D)."6&%./%*"&"=,"O.&05"('-":&1:&5$&/"2&'.*"4&5"0.<.00.-"%("%)."G.6&0%2./%"(<"X/-(-(/%$:5"<0(2"
%).""60$7&%."-./%$5%"%("%)."6&%$./%*"<(0".7&'1&%$(/"&/-"./-(-(/%$:"%0.&%2./%"(<"%)."0$8)%"2&K$''&0O"
<$05%"2('&0*"!=>"
"

Z$8>"=>!"F""Z0(/%&'"7$.4"H,>H3>,H!!"
"

Chief complaint Clinical findings

• T(" 5O26%(25" j" 6&%$./%" 4$5).5" %(" "
C..6"%((%)"!=>" D((%)" 75( 78( 7=(
• @.0<(0&%$(/"%)0(18)"%)."<10:&%$(/" 9('-" T(" T(" n.5"
" X@D"""HFfH" fH" fH" ;+"
@&'6&%$(/" T(" T(" "T("
@.0:155$(/" T(" n.5" T("
Q(E$'$%O" T(" T(" T("
@@G" ,"22" ,"22" ,"22"

Radiographic findings
"

"
Z$8>"=>,"&/-"=>3"F"U::'15&'"&/-"E1::&'"7$.4"H,>H3>,H!!"

Medical history
T("2.-$:&'")$5%(0O"

Dental history "

Z$8>"=>;"F"@.0$&6$:&'"0&-$(80&6)"j"%&C./"EO"%)."0.<.00$/8"
• 9(22./:.-"./-(-(/%$:"%0.&%2./%"&%" -./%$5%"E.<(0."./-(-(/%$:"%0.&%2./%"5%&0%.-"F"
%)." 6&%$./%" -./%$5%>" @.0<(0&%$(/" !H>H,>,H!!"
%)0(18)" %)." <10:&%$(/" 4)$'." '((C$/8" "

&<%.0"%)."0((%":&/&'5>""
• ?2&'8&2" 0.5%(0&%$(/" QU" &/-"
9(26(5$%."0.5%(0&%$(/"GU>""
"

" 3H"
 Problem list
• L&08."6.0<(0&%$(/"
• `.&'$/8"%)."6.0<(0&%$(/"
• L(:&%."%)."-$5%(FE1::&''O"0((%":&/&'"
• 0.5%(0&%$(/"&<%.0"%0.&%2./%"

Treatment progress
H,>H3>,H!!"
• 9'$/$:&'"&/-"0&-$(80&6)$:".K&2$/&%$(/>"
• G$5:155.-"%0.&%2./%"(6%$(/5>"
Hf>H3>,H!!"
" • [/5%012./%&%$(/"
Z$8>"=>I"F"@.0$&6$:&'"0&-$(80&6)"H,>H3>,H!!"
" • `.&'$/8"%)."0((%"6.0<(0&%$(/"
Tooth 15 ,c>H3>,H!!"
F @0.7$(15'O"./-(-(/%$:"%0.&%.-" • UE%10&%$(/"
F @(0:.'&$/":0(4/" • D.26(0&0O"<$''$/8"[AQ"
F D)." '&2$/&" -10&" :&/" E." <(''(4.-" ",c>H3>,H!,"
4$%)(1%"-$5016%$(/" • 9(/%0('"-(/."&%"%)."0.<.00$/8"-./%$5%>"
Tooth 16
F A&-$(" (6&B1." 0.5%(0&%$(/" 2.5$&'" &/-" Non-surgical endodontic
-$5%&'" treatment
F \(2(8./"0&-$('1:./:O"$/"%).":(0(/&'" First visit
6&0%" (<" %)." %((%)>" 9(0(/&'" 61'6" 9'$/$:&'" &/-" 0&-$(80&6)$:" .K&2$/&%$(/" 4&5"
(7.060(W.:%5"0&-$('1:./:O>"" :&00$.-"(1%>"A1EE.0"-&2"4&5"-$5$/<.:%.-"4$%)"
F ?6$:&'"0&-$('1:./:O"Q_"0((%>" H*IJ" 9\d" $/" +HJ" .%)&/('>" ?::.55"
F @?[";" 60.6&0&%$(/>" Z(10" 0((%" :&/&'5" 4.0." '(:&'$M.-"
Tooth 17 Q_*"Q_,*"G_"&/-"@*"&/-"%)."6.0<(0&%$(/"4&5"
F A&-$(" (6&B1." 0.5%(0&%$(/" 2.5$&'*" <(1/->" 9(/%$/1(15" .K1-&%$(/" <'(4" <0(2" %)."
(::'15&'"&/-"-$5%&'>" 6.0<(0&%$(/"
F D)." '&2$/&" -10&" :&/" E." <(''(4.-" "
4$%)(1%"-$5016%$(/>"

Diagnosis
@1'6&'" lH;>!"T.:0(%$:"61'6"
lH3>3!"[/%.0/&'"0.5(06%$(/"
@.0$&6$:&'" lH;>I"9)0(/$:"&6$:&'"
6.0$(-(/%$%$5"
@.0$(-(/%&'" N$%)$/"/(02&'"'$2$%5"
@?[" ;"2.5$&'"0((%"
" "
Z$8>"=>="j"9'$/$:&'"6)(%("(<"%)."&::.55":&7$%O"&/-"
6.0<(0&%$(/"Hf>H3>,H!!"
Treatment options "
• T(/F5108$:&'"./-(-(/%$:"%0.&%2./%" N(0C$/8" './8%)" 0&-$(80&6)" 4&5" %&C./" PZ$8"
• XK%0&:%$(/" =>+V>""
Treatment plan "
• `.&'$/8"(<"%)."6.0<(0&%$(/"4$%)"QD?"
• T(/F5108$:&'"./-(-(/%$:"%0.&%2./%"
"
D)." 6&%$./%" 4$5)" %(" C..6" %)." %((%)" &/-"
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3!" "
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Second visit
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XGD?>" ?" 2&5%.0:(/." 0&-$80&6)" P<$8" =>cV" 4&5"
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6.0<(0&%$(/" &0.&>" @&:C.-" `108$" @'&5%.0!" $/"
6&6.0" 6($/%5" &/-" <$''.-" 4$%)" ?\" 6'15" &/-"
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?/8.'15"QD?!>"Y5.-"%)."Q?@"5O5%.2>"
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"
" Z$8>"=>c"F"Q&5%.06($/%"0&-$(80&6)",c>H3>,H!!"
;%&1-4/&-#F+ "
- _105*"lF<'.K"<$'.5*"_$(A&:.*""
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 Control - after 1 year follow up
"

"
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Z$8>"=>!,"j"@.0$&6$:&'"0&-$(80&6)"%&C./"EO"%)."0.<.00.-"
-./%$5",c>H3>,H!,"
Before treatment
"
?%"%)."(/."O.&0":(/%0('"%)."6&%$./%")&-"/("
5O26%(25>"D).":(/%0('"4.0."-(/."EO"%)."
0.<.00.-"-./%$5%>"
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D((%)"!=")&7."0.:$.7.-"&":0(4/"&5"&"
6.02&/./%"0.5%(0&%$(/>"
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After treatment Evaluation

D)."-$<<$:1'%"6&0%"(<"%)$5":&5."4&5"%("5.&'"%)."
6.0<(0&%$(/>"D)."60(E'.2"4&5"%).":(/%$/1(15"
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2$/1%.5" 4$%)" /(" ).'6>" D)./" 4." 15.-"
`108$6'&5%.0" 4)$:)" $5" &" :&':$12" 51'<&%."
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$/" -./%$5%0O" &/-" &::.6%&E'." :(/-$%$(/" <(0"
QD?" 4.0." &:)$.7.->" 90(4/" 0.5%(0&%$(/" 4&5"
0.:(2./-.-" <(0" &" 6.02&/./%" 0.5%(0&%$(/" $/"
%)$5":&5.>"
"

" Discussion
@1'6" :)&2E.0" <'((0" 6.0<(0&%$(/5" :&15.-" EO"
Prognosis 0.5(06%$7."-.<.:%5*":&0$.5"(0"$&%0(8./$:".7./%5"
Endodontic
-10$/8" ./-(-(/%$:" 60(:.-10.5" &0."
- Z&7(0&E'."
1/-.5$0&E'." -&2&8.5>" [%" :0.&%.5" &/" &0%$<$:$&'"
Tooth
- Y/:.0%&$/" :(221/$:&%$(/" E.%4../" %)." 0((%" :&/&'"
Restoration 5O5%.2" %(" %)." 5166(0%$/8" %$551." (<" %)." %..%)"
- Y/:.0%&$/" &/-"%)."(0&'":&7$%O"P!V>"
D)." <0.B1./:O" (<" 0((%" 6.0<(0&%$(/" )&5" E../"
0.6(0%.-"%("0&/8."<0(2"3"J"%("!H"J"P,*3V>"
33" "

slal a l t a c h m c n i loss.
brations in lerms ol'
llic crcslal hone a n d
n ol" ihc pcrforalion
l ihc (rilical crcslal
whereas the iritiial
middle third o l t h c
oration in llic middle
cr\ atixc treatmen t is
Mesial zone.
th in\-ol\'cd, but
und in the un-
where Ueatmcnl
success rale iu
" Root perforations: classification and treatment
D)." &$2" (<" (E%10&%$/8" 6.0<(0&%$(/5" $5" %("
D)."&$2"(<"%)."6.0<(0&%$(/"2&/&8.2./%"$5"%(" 60.7./%" E&:%.0$&" <0(2" %)." (0&'" :&7$%O" <0(2"
2&$/%&$/" ).&'%)O" 6.0$(-(/%&'" %$551.5" &8&$/5%" 0.&:)$/8" %)." 6.0$0&-$:1'&0" %$551.5*" &/-" %("
%)." 6.0<(0&%$(/" 4$%)(1%" 6.05$5%./%" &7($-"$00$%&%$(/5"(<"%)."6.0$(-(/%&'"%$551.5"EO"
$/<'&22&%$(/" (0" '(55" (<" 6.0$(-(/%&'" .5K%015$(/"(<"5.&'$/8"2&%.0$&'5"P!V>"
&%%&:)2./%>" #&0$(15" 2&%.0$&'5" )&7." E../" 15.-" %(" 0.6&$0"
@0(8/(5$5" (<" &" %((%)" 4$%)" 6.0<(0&%$(/" $5" 0((%" 6.0<(0&%$(/5>" QD?" $5" (/." (<" %)." 2(5%"
-.6./-./%"(/"%)."60.7./%$(/"(0"%0.&%2./%"(<" :(22(/'O"15.-"0.6&$0"2&%.0$&'>"
E&:%.0$&'" $/<.:%$(/" (<" %)." 6.0<(0&%$(/" 5$%.>" QD?" 0.B1$0.5" 60.5./:." (<" 4&%.0" 5.%%$/8>"
`.7.0&'" Z&:%(05" 0.'&%.-" %(" $/<.:%$(/" (<" %)." D).0.<(0*" 5.%" QD?" :&/" &B1$0." $%5" (6%$2&'"
6.0<(0&%$(/"5$%."&<<.:%.-"%)."60(8/(5$5"(<"%)." 5%0./8%)" &/-" 60(-1:." .K:.''./%" 5.&'&E$'$%O" $/"
%0.&%2./%" (<" 0((%" 6.0<(0&%$(/5>" D)." 2(5%" %)."60.5./:."(<"2($5%10.""P=V"
$26(0%&/%" &0.a" %)." 5$M." &/-" %)." '(:&%$(/" (<" QD?" $5" :(26(5.-" (<" %0$:&':$12" 5$'$:&%.*"
%)."6.0<(0&%$(/*"&/-"%)."%$2."P!V>"" %0$:&':$12" &'12$/&%.*" %0$:&':$12" (K$-.*"
_.&7.05" .%" &'" 0.6(0%.-" &" )$8)" 51::.550&%." $/" 5$'$:&%." (K$-.*" 2$/.0&'" (K$-." &/-" E$521%)"
Fig. 7. D i a g r a m of nKmdihnlar molar wilh pc-rforalion in llic iitiddlc
6.0$(-(/%&'"
third o\ lh(~ mesial ).&'$/8" 4)$:)"
rool. Tlu' |)rognosis for c 4&5"
o n s c r \ a l i&%%0$E1%.-"
\ c ircalmcnl is (K$-.>"D)."6(4-.0":(/5$5%"(<"<$/.")O-0(6)$'$:"
2&$/'O" %(" $22.-$&%." (E%10&%$(/" (<" %)."
good hc{ aiisc ihc ])crforalion is lotatt'd apit'al to ihc critic al ( rcslal
zone.
6&0%$:'.5" %)&%" )&0-./" $/" %)." 60.5:./:." (<"
6.0<(0&%$(/5" &/-" &/" &5.6%$:" %.:)/$B1." P;V>" 4&%.0>"\O-0&%$(/5"(<"%)."6(4-.0"'.&-5"%("%)."
D)." 5$M." (<" %)." 6.0<(0&%$(/" )&5" &'5(" &/" <(02&%$(/" (<" &" :(''($-&'" 8.'*" 4)$:)" %)./"
$26(0%&/%"
peidodotital healing' .<<.:%" which (/" was %)."attributed
60(8/(5$5" mainly (<"
to 5('$-$<$.5" %(" &" )&0-" 5%01:%10." $/" &60(K$2&%.'O"
immediate obturation of the perforations and an
%0.&%2./%>"
aseptic technique. \$2.'" .%" &'" <(1/-" %)&%" %)." ;")"P+V>""
60(8/(5$5" (<" %0.&%2./%" 4&5" -$0.:%'O" D(0&E$/.W&-" .%" &'" :(26&0.-" %)." 5.%%$/8" %$2."
60(6(0%$(/&'"
Size 4$%)" %)." 5$M." (<" %)." %((%)S" %)." &/-" :(260.55$7." 5%0./8%)" (<" <(10" -$<<.0/%"
'&08.0" %..%)"
The size of a perforation 4$%)" 60(6(0%$(/&'O"
also has an important 52&''.0"
cfTcct 2&%.0$&'5S" &2&'8&2*" `16.0" X_?*" [AQ" &/-"
6.0<(0&%$(/5")&-"%)."E.5%"0.51'%5"PIV>"
on the prognosis of treatment. A stnall jDerforation QD?>" QD?" )&-" %)." '(/8.5%" 5.%%$/8" %$2." &/-"
is usually associated with less tissue destruction and
D)."'(:&%$(/"(<"&"6.0<(0&%$(/"$5"60(E&E'O"%)."
itinatiitiiation; thcrcibtv. healing- is more predictable.
%)." '(4.5%" :(260.55$7." 5%0./8%)*" &/-" %)."
2(5%"
Himel$26(0%&/%"
ct al. [\{)) ha\c <&:%(05" &<<.:%$/8"
e\'aluaicd the eflect %0.&%2./%"
of three 5%0./8%)"$/:0.&5.-"&<%.0",!"-&O5"PfV>"L..".%"&'"
60(8/(5$5>" D)." :0$%$:&'" M(/." $/" %.025"
materials on the biological repair of a defect (<"
created <(1/-" %)&%" QD?" &'5(" )&-" 516.0$(0" 5.&'$/8"
by perforating the J^ulp chatnbcr floor of mandibular
60(8/(5$5"$5"%)."'.7.'"(<"%).":0$5%&'"E(/."&/-"
posterior teeth iti dogs. It was ibmid that the prog- &E$'$%O" :(26&0.-" %(" &2&'8&2" (0" [AQ" 4)./"
%)."
nosis .6$%).'$&'"
of treatment was &%%&:)2./%>"
dirccih' j^roportional @.0<(0&%$(/"
with the 15.-"<(0"6.0<(0&%$(/"0.6&$0"PcV>""
size ofthe tooth: the larger teeth (with proportiotially
:(0(/&'" %(" %)." :0.5%&'" E(/." &/-" .6$%).'$&'"
smaller perforations) had the best results. Since the
`.7.0&'" $/" 7$7(" &/$2&'" 5%1-$.5" )&7." 0.6(0%.-"
&%%&:)2./%"
aim of obturating )&5" 8((-" 60(8/(5$5>"
pcrlbrations is to pre\@.0<(0&%$(/"cnt l)a( tcMia %)&%"QD?"$5"&"E$(:(26&%$E'."2&%.0$&'"4$%)"/("
&%"from%)."the:0.5%&'"
oral ca\iiyE(/." '.7.'" &/-"
Irom reaching .6$%).'$&'"
the periradicular &-7.05." .<<.:%5" (/" %)." -./%&'" %$551.>" D).5."
tissues, and lo avoid irritation ol ihe j^criodontal
&%%&:)2./%" )&5" &" 6((0" 60(8/(5$5>"" 5%1-$.5" $-./%$<$.-" :.''5" '$/.-" &'(/8" %)." QD?"
@.0<(0&%$(/" &6$:&'" %(" %)." :0.5%&'" E(/." &/-" 510<&:.*" <10%).0" 5166(0%$/8" %)&%" QD?" )&5"
.6$%).'$&'" &%%&:)2./%" )&5" 8((-" 60(8/(5.5"
Table t. Classification of root perforations according to factors which affect
prognosis. To the left of the horizontal line are predictors suggestive of a good
'$%%'." (0" /(" :O%(%(K$:$%O" P!H*" !!*" !,V>"
P!V>"
prognosis while to the right are factors suggestive of a poor prognosis D(0&E$/.W&-" .%" &'" 5)(4.-" %)&%" QD?" 4&5"
Root perforation :(7.0.-" 4$%)" :.2./%12" '&O.0" 4)./" 15.-" &5"
Lateral or furcal
&" 0((%F./-" <$''$/8" 2&%.0$&'" $/" 2(/C.O5" P!,V>"
Fresh Old
Small Large ?/-" @$%" Z(0-" .%" &'" 0.6(0%.-" :(/%$/1(15" )&0-"
Apical-coronal Crestal
%$551."<(02&%$(/"&0(1/-".K:.55"QD?"2&%.0$&'"
Good prognosis Poor prognosis 4)./"$%"4&5"15.-"%("0.6&$0"&"6&0<(0&%$(/"P!3V>"
"
D&E'."(<":'&55$<$:&%$(/"(<"0((%"6.0<(0&%$(/5"&::(0-$/8"%(" "
257 D)." %4(" 2&$/" :)&''./8.5" &" :'$/$:$&/" <&:.5"
<&:%(05"4)$:)"&<<.:%"60(8/(5$5"P!V>"
" 4)./" &%%.26%$/8" %(" 0.6&$0" &" 6.0<(0&%$(/" &0."
@.0<(0&%$(/" $/" %)." <10:&%$(/" )&7." 6((0" ).2(5%&5$5" &/-" :(/%0(''.-" 6'&:.2./%" (<" &"
60(8/(5$5" 5$/:." %)." <10:&" $5" 151&''O" :'(5." %(" 0.5%(0&%$7." 2&%.0$&'>" QD?" 5.%5" $/" %)."
%)." :0.5%&'" E(/.*" 4)$'." '&%.0&'" :(1'-" E." 60.5./:." (<" 2($5%10." &/-" E'((-" -(.5" /(%"
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Clinical findings
"
D((%)" 77( 37( 33(
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Q(E$'$%O" T(" T(" T("
Medical history @@G" ,"22" ,"22" ,"22"
T("2.-$:&'")$5%(0O"(
Radiographic findings
Dental history "
D((%)",!*"60.7$(15'O"%0&12&>""
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:'$/$:" 4$%)" :(26(5$%." &/-" <(''(4.-" 16" 4$%)"
5.7.0&'":(/%0('>"
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"

3+" "
 Tooth 11 • 9(/%0('","!^,"O.&05"<(''(4"16"
F U6./"&6.K"j"$22&%10."%((%)>"
F A&-$("(6&B1."0.5%(0&%$(/"2.5$&'>" Non-surgical endodontic
Tooth 21 treatment
F [22&%10."%((%)>" First visit
F U6./"&6.K>" 9'$/$:&'" &/-" 0&-$(80&6)$:" .K&2$/&%$(/" 4&5"
F ?6$:&'"0&-$('1:./:O" :&00$.-"(1%>"?/.5%).5$&"D(6$:&'."P_./M(:&$/.V"
F A((%" :&/&'" <$''.-" 4$%)" 0&-$(" (6&B1." &/-"!"K"`.6%(:&$/."]"4&5"&66'$.-"%(".5%&E'$5)"
2&%.0$&'>" &/.5%).5$&>"A1EE.0"-&2"4&5"-$5$/<.:%.-"4$%)"
F A&-$("(6&B1."0.5%(0&%$(/>" H*IJ" 9\d" $/" +HJ" .%)&/('>" D)." [AQ" <$''$/8"
Tooth 22 0.2(7.-" EO" E100" &/-" $/%0&:&/&'" -0.55$/8"
- U6./"&6.K"j"$22&%10."%((%)" 0.2(7.-"EO"$00$8&%$(/"4$%)"!J"T&U9'"&/-"!+"
J" XGD?>" D)." './8%)" (<" %)." 0((%" :&/&'" 4&5"
Diagnosis -.%.02$/.-" EO" 4(0C$/8" './8%)" 0&-$(80&6)"
@1'6&'" lH;>!"T.:0(%$:" PZ$8"+>IV>"
@.0$&6$:&'" lH;>IH"9)0(/$:"&6$:&'" G$-"/(%"2&/&8."%("0.2(7."%)."[AQ"<0&82./%"
6.0$(-(/%$%$5" $/"%)."0((%":&/&'>"
@.0$(-(/%&'" T(02&'" "
" ""

Treatment options
- ?6.K$<$:&%$(/"
- A.8./.0&%$(/"
- XK%0&:%$(/"&/-"(0%)(-(/%$:"%0.&%2./%""

Treatment plan
• ?6.K$<$:&%$(/"
o UE%10&%." 4$%)" QD?*"
81%%&6.0:)&*" [AQ" &/-"
9(26(5$%.>"
• 9(/%0('"
"
Problem list Z$8>"+>I"F"N(0C$/8"'./8%)"0&-$(80&6)"!H>H,>,H!!"
• U6./"&6.K"" +
• 2&C."&"QD?"6'18" ;%&1-4/&-#F+
• A.2(7."%)."[AQ"<0(2"%)."0((%":&/&'" - _105*"_$(A&:.*"lF<$'.5*"T$D$"
• ?/K$(15"6&%$./%*"&/-"6&0./%5" |!HH^>H,"j",3"22"
• A((%"<0&:%10."E.:&15."%)."0((%"$5"%)$/" - [00$5&<.]"
$/"%)."&6$:&'"6&0%>"" G1%)/&-#F+
• Y/:.0%&$/"60(8/(5$5"(<"%)."%((%)" - !J"T&U9'"o"!H"2'+J+!+J"XGD?"o"I"2'+
Treatment progress - @&55$7."1'%0&5(/$:"$00$8&%$(/*""
!H>H,>,H!!" T&U9'*"3"K",H"5>"
• 9'$/$:&'"&/-"0&-$(80&6)$:".K&2$/&%$(/>" E4'.-&-4-#+)%5/&-)%4'F+
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• [/5%012./%&%$(/" <%)$(.-.*+,/##/40F+
HI>HI>,H!!" - 9&7$%"R"&/-"[AQ>"
• A.2(7.-" %)." [AQ" <0&82./%*" "
Second visit
(E%10&%$(/"4$%)"QD?"6'18>"
T("5O26%(25"5$/:."'&5%"%0.&%2./%>"
,;>HI>,H!!"
• UE%10&%$(/" 4$%)" 81%%&F6.0:)&*" [AQ" A1EE.0"-&2"F"H*IJ"9\d"$/"+HJ".%)&/('>"D)."
&/-":(26(5$%.>" [AQ" <$''$/8" 0.2(7.-" EO" E100" &/-" $/%0&:&/&'"
,+>!!>,H!," -0.55$/8" 0.2(7.-" EO" $00$8&%$(/" 4$%)" !J"
" 3f"
T&U9'"&/-"!+"J"XGD?>"D)."[AQ"<0&82./%"4&5" - [00$5&<."1'%0&5(1/-+
'(:&%.-" 6&'&%$/&'" $/" %)." 0((%" :&/&'>" Q&/&8.-" KA'".-'/(4+
%("0.2(7."%)."<0&82./%"4$%)"1'%0&5(1/-"lF,I" - R1%%&"6.0:)&"&/-"?\F6'155+
<$'.>" [00$8&%.-" %)." 0((%" :&/&'>" D)." 0((%" :&/&'" - [AQ+
4.0." -0$.-" 4$%)" 5%.0$'." 6&6.0" 6($/%5" &/-" !%.)-4%4'+.%3'(.-'/(4+
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9&7$%"R"&/-"[AQ" "
" Z$8>"+>fF"Z$/&'"0&-$(80&6)",;>HI>,H!!"

Before treatment
"

" "
Z$8>"+>="&/-"+>+"j"@.0$&6$:&'"0&-$(80&6)"(<"0.2(7.-"
[AQ"&/-"4$%)"QD?"6'188"HI>HI>,H!!" "
After treatment
Third visit
"
T("5O26%(25"5$/:."'&5%"%0.&%2./%"
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6.02&/./%"<$''$/8"PZ$8"+>fV>"
"
G1%)/&-#F+
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"
3c" "
 Prognosis Q$/.0&'" %0$(K$-." &880.8&%." PQD?V" 4&5"
Endodontic -.7.'(6.-" &/-" 0.:(22./-.-" $/$%$&''O" &5" &"
- Z&7(0&E'." 0((%F./-" <$''$/8" 2&%.0$&'" &/-" 51E5.B1./%'O"
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- Y/:.0%&$/" &6.K(8./.5$5*" &6$:&'" E&00$.0" <(02&%$(/" $/"
Restoration
%..%)" 4$%)" (6./" &6.K.5*" 0.6&$0" (<" 0((%"
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6.0<(0&%$(/5*" &/-" &5" &" 0((%" :&/&'" <$''$/8"
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5100(1/-$/8" %$551.5*" E1%" &'5(" -.2(/5%0&%.-"
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"
" N)./"&":)$'-v5"%((%)"$5"%0&12&%$M.-*"%)."61'6"
Z$8>"+>c"j"9'$/$:&'"6)(%(80&6)",+>!!>,H!3"
" 2&O" /(%" 5107$7." %)." $/W10O>" [<" %)&%" )&66./5*"
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%((%)" 4$%)" %)$/*" <0&8$'." 0((%" :&/&'" 4&''5" &/-"
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" )&5"E../"0.6(0%.-"%)&%"&60(K$2&%.'O"3H"J"(<"
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D)." 6.0$&6$:&'" 0&-$80&6)" 5)(4" .7$-./:." (<" $22&%10." %..%)" )&7." -$5&-7&/%&8." (<"
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" :.07$:&'"0((%"<0&:%10.>"
"
Discussion QD?" $5" &/" &'%.0/&%$7." 2&%.0$&'" %(" :&':$12"
?6.K$<$:&%$(/" $5" -.<$/.-" &5" &" 2.%)(-" (<" )O-0(K$-." <(0" 60(-1:$/8" &/" &6$:&'" E&00$.0>"
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-.7.'(62./%"(<"&/"$/:(26'.%.'O"<(02.-"0((%" QD?"<(0"15."&5"&/"&6$:&'"E&00$.0")&7."0.6(0%5"
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U/." (<" %)." 60(E'.25" $/" 2&/&8$/8" $22&%10."
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)&7." 5)(4/" %)&%" %)." :.07$:&'" &0.&" :&/" E."
5%0./8%)./.-" E(%)" E.<(0." &/-" &<%.0"
&6.K$<$:&%$(/" 60(:.-10.5" EO" E(/-$/8" 0.5$/"
2&%.0$&'5" $/%(" %)." 6(%./%$&''O" <0&:%10.F60(/."
&0.&5" (0" $/%(" %)." :&/&'" %(" '.7.'" E.'(4" %)."
:0.5%"(<"&'7.('&0"E(/.>""
D)$5"5%1-$.5")&7."'(4".7$-./:."5$/:."%).O"&0."
:&5."0.6(0%5"&/-"/4+:/'.("5%1-$.5"P!!*"!,*"!3V>""
L(/8F%.02"0.51'%5"&0."'&:C$/8>"
?%"60.5./%"%).0."$5"/("60(56.:%$7."'(/8F%.02"
(1%:(2." 5%1-O" %)&%" :(26&0.5" %)." 51::5.55"
0&%." (<" %)." %0&-$%$(/&'" :&':$12" )O-0(K$-."
%.:)/$B1."&/-"%)."QD?"%.:)/$B1."P!;V>"
" !H> Q((0." ?*" \(4'.O" QZ*" Uv9(//.''" ?9>"
References
!> ??X" R'(55&0O" j" 9(/%.26(0&0O"
D.02$/('(8O" <(0" X/-(-(/%$:5>"
?2.0$:&/" ?55(:$&%$(/" (<"
X/-(-(/%$5%5*"9)$:&8(*"!ccf>"
,> @&0$0(C)" Q*" D(0&E$/.W&-" Q>" Q$/.0&'"
D0$(K$-."?880.8&%.S"?"9(260.)./5$7."
L$%.0&%10." 0.7$.4" j" @&0%" !S" 9).2$:&'*"
@)O5$:&'" &/-" ?/%$E&:%.0$&'" 60(6.0%$.5>"
h"X/-(-",H!Ha"3=S"!=F,+>"
3> Q&$/" 9*" Q$0M&O&/" T*" `)&E&)&/8" `*"
D(0&E$/.W&-" Q>" A.6&$0" (<" 0((%"
6.0<(0&%$(/5" 15$/8" 2$/.0&'" %0$(K$-."
&880.8&%.S" &" '(/8F%.02" 5%1-O>" h>"
X/-(-a",HH;S"3HS"fHFf3>"
;> ?/-0.&5./" hU*" ?/-0.&5./" ZQ*"
?/-.055(/" L>" D.K%E((C" &/-" 9('(0"
?%'&5" (<" D0&12&%$:" [/W10$.5" %(" %)."
D..%)>";%)".->"_'&:C4.''"Q1/C58&&0->"
I> \.$%).05&O" R`>" 9&':$12" )O-0(K$-." $/"
%)." %0.&%2./%" (<" 61'6'.55" %..%)" 4$%)"
&55(:$&%.-" 6&%)('(8O>" h" _0" X/-(-" `(:"
!c+Ia"fS"+;Fc3>"
=> l.0.C.5" l*" \.$-." `*" h&:(E5./" [>"
Z(''(4F16" .K&2$/&%$(/" (<" ./-(-(/%$:"
%0.&%2./%" $/" %0&12&%$M.-" W17./$'"
$/:$5(05>"h"X/-(-"!cfHa"=S"+;;Ff>""
"
"
"
"
"
;!"
+> 97.C" Q>" @0(8/(5$5" (<" '1K&%.-" /(/F
7$%&'" 2&K$''&0O" $/:$5(05" %0.&%.-" 4$%)"
:&':$12" )O-0(K$-." &/-" <$''.-" 4$%)"
81%%&" 6.0:)&" ?" 0.%0(56.:%$7." :'$/$:&'"
5%1-O>"X/-(-"G./%"D0&12&%('"!cc,a"fS"
;IFII>"
f> ['&6(81"`*"_&C'&/-"Ll*"@.%.05(/"h*"l$2"
h>"D).".<<.:%"(<"T&U9'*"9&PU\V,*"QD?"
&/-" QD?G" (/" 0((%" -./%$/" <0&:%10."
0.5$5%&/:.>" Q&5%.0v5" %).5$5*" R0&-1&%."
`:)(('*"L(2&"L$/-&"Y/$7.05$%O*",HH;>"
c> `)&E&)&/8" `*" D(0&E$/.W&-" Q>"
D0.&%2./%" (<" %..%)" 4$%)" (6./" &6$:.5"
15$/8" 2$/.0&'" %0$(K$-." &880.8&%.>"
@0&:%" @.0$(-(/%" ?.5%).%" G./%" ,HHHa"
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D0.&%2./%" (<" (6./" &6.K" %..%" )15$/8"
%4(" %O6.5" (<" 4)$%." 2$/.0&'" %0$(K$-."
&880.8&%." &<%.0" $/$%$&'" -0.55$/8" 4$%)"
:&':$12" )O-0(K$-." $/" :)$'-0./>" G./%"
D0&12&%('>",H!!a",+S"!==F+3>"
!!> D0(6." Q*" Q&'%M" GU*" D0(/5%&-" L>"
A.5$5%&/:." %(" <0&:%10." (<" 0.5%(0.-"
./-(-(/%$:&''O" %0.&%.-" %..%)>" X/-(-"
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!,> A&E$."R*"D0(6."Q*"R&0:$&"9*"D0(/5%&-"
L>" `%0./8%)./$/8" &/-" 0.5%(0&%$(/" (<"
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0.5$/" %.:)/$B1.>" X/-(-" G./%"
D0&12&%('"!cfIa"!S",;=FI=>"
!3> \.0/&/-.M" A*" _&-.0" `*" _(5%(/" G*"
D0(6." Q>" A.5$5%&/:." %(" <0&:%10." (<"
./-(-(/%$:&''O" %0.&%.-" 60.2('&05"
0.5%(0.-" 4$%)" /.4" 8./.0&%$(/" -./%$/"
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?6$:&'" @.0$(-(/%$%$5>" G./%" 9'$/" T" ?2>"
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 Case 8

>#<"<"#2)*-2'.+26.#2-"8-+-6+9),,+'7-,.82-,+2.'+,-:)23-*3'"#)*-+5)*+,-5.')"<"#2)2)%@
D)."6&%$./%*"&",H"O.&0"('-"&<0$:&/"<.2&'.*"4&5"0.<.00.-"%("%)."G.6&0%2./%"(<"X/-(-(/%$:5"<0(2"%)."
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"

Z$8>"f>!"F""Z0(/%&'"7$.4"!c>HI>,H!!"
"

Chief complaint
D)." 6&%$./%" <..'" %./-.0/.55" 4)./" 6&'6&%$(/"
%)."%((%)",,>" Radiographic findings
"

"
Z$8>"f>,"&/-"f>3"j"Z0(/%&'"&/-"6&'&%$/&'"7$.4"
!c>HI>,H!!"

Medical history
T("2.-$:&'")$5%(0O"

Dental history
• @0.7$(15'O" %0&12&" ,H!H" F" E$C."
&::$-./%>" G$-" /(%" /..-" &/O" "
Z$8>"f>;"F"@.0$&6$:&'"0&-$(80&6)"F"!c>HI>,H!!"
.2.08./:O"-./%&'"%0.&%2./%"&<%.0"%)." "

&::$-./%*"/("7$5$E'."5$8/>" Tooth 21
• U/8($/8"(0%)(-(/%$:"%0.&%2./%" F U0%)(-(/%$:"E0&:C.%5"
F D)." '&2$/&" -10&" :&/" E." <(''(4.-"
Clinical findings 4$%)(1%"-$5016%$(/>"
" Tooth 22
D((%)" 37( 33( 3<( F U0%)(-(/%$:"E0&:C.%5"
9('-" n.5" T(" n.5" F ?6$:&'"0&-$('1:./:O"
X@D"""HFfH" F" F" F" F @?[";"
@&'6&%$(/" T(" n.5" T("
Diagnosis 19.05.2011
@.0:155$(/" T(" T(" " @1'6&'" lH;>!"T.:0(%$:"
Q(E$'$%O" T(" T(" " @.0$&6$:&'" lH;>I"9)0(/$:"&6$:&'"
@@G" ,"22" ,"22" ,"22" 6.0$(-(/%$%$5"
@.0$(-(/%&'" N$%)"$/"/(02&'"'$2$%5"
@?[" ;"
" ;,"
 Treatment options
• T(/F5108$:&'"./-(-(/%$:"%0.&%2./%"
• XK%0&:%$(/"

Treatment plan
! T(/"5108$:&'"%0.&%2./%"
, @.02&/./%"<$'$/8"j":(26(5$%."
"
D)." 6&%$./%" 4$5).5" %(" C..6" %)." %((%)*" &/-"
&::.6%"%)."./-(-(/%$:"%0.&%2./%>"
"
Z$8>"f>I"F"N(0C$/8"'./8%)"0&-$(80&6)"!c>HI>,H!!"
Problem list "
• `&%$5<&:%(0O" &5.6%$:" :(/-$%$(/5*" ;%&1-4/&-#F+
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 Case 9

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Clinical findings 06.03.2013
Medical history "
T("2.-$:&'")$5%(0O" D((%)" 37( 33( 3<(
9('-" n.5" T(" n.5"
Dental history
• U'$8(-(/%$" !I*" !;*" !,*" ,,*" ,;*" ,I*" 3f*" X@D"""HFfH" ;H" fH" 3+"
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 Radiographic findings
"

"
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Tooth 22
F U0%)(-(/%$:"E(/-.-"0.%&$/.0"
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Radiographic findings – history

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"
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" Problem list
• L(:('&$M."%)."0((%":&/&'P5V"
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Treatment progress
H=>H3>,H!3"
• 9'$/$:&'"&/-"0&-$(80&6)$:".K&2$/&%$(/>"
• G$5:155.-"%0.&%2./%"(6%$(/5>"
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"
Z$8>"c>c"j"9_9D"H=",H!," H3>H;>,H!3"
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• 9(/%0('"

Endodontic treatment
First visit
9'$/$:&'" &/-" 0&-$(80&6)$:" .K&2$/&%$(/" 4&5"
:&00$.->"D)."6&%$./%"%)(18)%"5)."4&5"8($/8"%("
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Y/$7.05$%O"(<"U5'(>"
"
Second visit
Diagnosis A1EE.0" -&2" 4&5" -$5$/<.:%.-" 4$%)" H*IJ" 9\d"
@1'6&'" lH;>!"T.:0(%$:" $/" +HJ" .%)&/('>" D)." &::.55" :&7$%O" 4&5"
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@.0$(-(/%&'" N$%)$/"/(02&'"'$2$%5" %).":./%.0"(<"%)."61'6":&7$%O>"
@?[" ;" "

Treatment options
• XK%0&:%$(/" &/-" $26'&/%5" (0"
(0%)(-(/%$:"%0.&%2./%>"

Treatment plan
o T(/F5108$:&'"%0.&%2./%"

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"
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|H=*" |Hf*" |!H" &/-" |!I" !I" 22" _9" %(" :0.&%." Fourth visit
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9\d" &/-" !+J" XGD?" 4.0." 15.-" <(0" :).2$:&'" Y'%0&5(1/-" $00$5&<." &/-" H*I" J" 9\d" &/-" !+" J"
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"
Third visit
T("5O26%(25"5$/:."'&5%"%0.&%2./%>"
"
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R&%.5" R'$--./" E10" &/-" _$(0&:.>" H*I" J" 9\d"
&/-" !+" J" XGD?" 4.0." 15.-" <(0" :).2$:&'" 0((%"

I!" "
 Control - after 9 months
"

Z$8>" c>!;" F" Q&5%.06($/%" &/-" <$/&'" 0&-$(80&6)"

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"
Before treatment Z$8>"@Q>!;"j"@.0$&6$:&'"0&-$(80&6)"F":(/%0('"c"2(/%)5"
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@?["3>"Z10%).0"<(''(4"165"$5"/.:.55&0O>"
"

Discussion
" D)." 2.%)(-" <(0" &1%(%0&/56'&/%&%$(/" (<"
$22&%10." 60.2('&05" 4&5" -.7.'(6.-" &%" %)."
After treatment
Y/$7.05$%O" (<" U5'(*" T(04&O*" EO" G05" `'&857('-"
"
&/-" _W.0:C.*" &/-" <$05%" -.5:0$E.-" $/"
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&<%.0" )&7$/8" )&-" 60.2('&05" %0&/56'&/%.-"
<0(2"(/."0.8$(/"%("&/(%).0"P!V>"
D)." <$05%" 5%.6" $/" %)." 5108$:&'" 60(:.-10." $5"
60.6&0&%$(/"(<"&"5(:C.%"$/"%)."0.:$6$./%"&0.&S"
%)." -(/(0" %((%)" 8.02" $5" %)./" :&0.<1''O"
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" 6(55$E'.>" D)." %0&/56'&/%.-" %..%)" &0." 6'&:.-"
Prognosis (1%"(<"(::'15$(/"&/-"5.:10.-"4$%)"51%10.5"<(0"
Endodontic &"6.0$(-"(<"!"%(","4..C5>"D)."60.2('&0.5"&0."
- Z&7(0&E'." 0.5%(0.-" %(" 2&K$''&0O" :./%0&'" $/:$5(0"
Tooth 2(06)('(8O" EO" .$%).0" &" :(26(5$%." 0.5$/"
- Z&7(0&E'." E1$'-F16"(0"&"6(0:.'&$/"'&2$/&%."7./..0"P!V>""
Restoration [/" &" )$5%(:).2$:&'" -.2(/5%0&%$(/" (<"
- Z&7(0&E'." (K$-(0.-1:%&5." &:%$7$%O" $%" &66.&05" %)&%" %)."

" I,"
61'6" (<" %)." 0.6'&/%.-" &/-" &1%(%0&/56'&/%.-"
%..%)" 4$%)" 6&0%'O" <(02.-" 0((%5" <$05%"
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D)."0.7&5:1'&0$M&%$(/"(<"%)."61'6"&66.&0.5"%("
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 Case 10

>#<"<"#2)*-2'.+26.#2-"8-23.-6+#<)?&,+'-')(32-8)'%2-5'.6",+'-:)23-*3'"#)*-+5)*+,-
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Radiographic findings
"
" "
Z$8>"!H>,"&/-"!H>3"F"U::'15&'"7$.4"&/-".K%0&"(0&'"7$.4"
,I>Hc>,H!3"

Medical history
T("2.-$:&'"%0.&%2./%"%(-&O"
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Dental history
D)." 6&%$./%" 4./%" %(" ).0." -./%$5%" <(0" &E(1%" "
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II"
Tooth 43
F L&2$/&" -10&" :&/" E.." <(''(4.-"
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Tooth 45
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F A&-$("(6&B1."<$''$/8"(::'15&'"
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Tooth 46
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F A&-$("(6&B1."<$''$/8"(::'15&'"
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Endodontic treatment
First visit
9'$/$:&'" &/-" 0&-$(80&6)$:" .K&2$/&%$(/" 4.0."
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Diagnosis
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Treatment options +
• T(/F5108$:&'"./-(-(/%$:"%0.&%2./%"
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Treatment plan
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Treatment progress +
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" Before treatment
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After treatment
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Prognosis
Endodontic
- Z&7(0&E'."
Tooth
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Restoration
" - Z&7(0&E'."
Z$8>"!H>f"F"Q&5%.06($/%"0&-$(80&6)"3!>!H>,H!3"
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Discussion
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Dental history Tooth 18
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Problem list
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+!*;J" (<" %)." :&5.5" 4).0." %)." $/5%012./%"
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References
!> N&'$&"\*"_0&/%'.O"N?*"R.05%.$/"\>"?/"
$/$%$&'" $/7.5%$8&%$(/" (<" %)." E./-$/8"
&/-" %(05$(/&'" 60(6.0%$.5" (<" /$%$/('"
0((%" :&/&'" <$'.5>" h" X/-(-(/" !cffa" !;S"
3;=FI!>"
,> `&%%&6&/"_*"T.07("R"h*"@&'&2&0&"h"X?*"
Q.55.0" \" \>" G.<.:%5" $/" 0(%&0O" /$:C.'F
%$%&/$12" <$'.5" &<%.0" :'$/$:&'" 15.>" h"
X/-(-(/",HHHa",=S"!=!FI>"
3> \w'52&//" Q*" `:)$/C.'" [>" [/<'1./:." (<"
5.7.0&'" <&:%(05" (/" %)." 51::.55" (0"
<&$'10." (" <0.2(7&'" (<" <0&:%10.-"
$/5%012./%5" <0(2" %)." 0((%" :&/&'>"
" =;"
 X/-(-"G./%"D0&12&%('"!ccca"!IS",I,F f> A1--'." 9h>" T(/5108$:&'" 0.%0.&%2./%"
f>"" [/S" 9()./" `*" _10/5" A9*" .-5>" @&%)4&O5"
;> `%0$/-E.08"Lr>"D)."-.6./-./:."(<"%.)" (<" %)." 61'6>" f%)" .->" `%>" L(1$5S" 9#"
0.51'%5" (<" 61'6" %).0&6O" (/" :.0%&$/" 2(5EO*",HH,Sf+IFc,c>"
<&:%(05>" ?:%&" U-(/%('" `:&/-" !cI=a" c> `Ws80./" Y*" \&88'1/-" _*" `1/-B7$5%" R*"
!;P`166'",!VS"!F!I=>" N$/8" l" P!ccHV>" Z&:%(05" &<<.:%$/8" %)."
I> 90126" Q9*" T&%C$/" X>" A.'&%$(/5)$6" (<" '(/8F%.02" 0.51'%5" (<" ./-(-(/%$:"
E0(C./" 0((%" :&/&'" $/5%012./%5" %(" %0.&%2./%>"h(10/&'"(<"./-(-(/%$:5"!=*"
./-(-(/%$:" :&5." 60(8/(5$5S" &" :'$/$:&'" ;cfFIH;>"
$/7.5%$8&%$(/>" h" ?2" G./%" ?55(:" !c+Ha" !H> l.0.C.5" l*" D0(/5%&'" L>" L(/8F%.02"
fHS"!3;!F+>" 0.51'%5" (<" ./-(-(/%$:" %0.&%2./%"
=> N&0-" h" A*" @&0&5)(5" @*" Q.55.0" \" \>" 6.0<(02.-" 4$%)" &" 5%&/-&0-$M.-"
X7&'1&%$(/"(<"&/"1'%0&5(/$:"D.:)/$B1." %.:)/$B1.>"h"X/-(-"!c+caISf3FcH>"
%(" 0.2(7." <0&:%10.-" 0(%&0O" /$:C.'F !!> Y/8.0.:)%5" 9*" _q0-5./" ?*" Z0$5%&-" [>"
%$%&/$12" ./-(-(/%$:" $/5%012./%5" [/5%012./%" <0&:%10." $/" 0((%" :&/&'5" j"
<0(2" 0((%" :&/&'5S" ?/" .K6.0$2./%&'" 4).0.*"4)O*"4)./"&/-"4)&%u"?"5%1-O"
5%1-O>"[Xh",HH3>" <0(2" &" 5%1-./%" :'$/$:>" [/%.0/&%$(/&'"
+> `1%.0" _*" L155$" ?*" `.B1.$0&" @>" X/-(-(/%$:" h(10/&'" ,H!;a" ;+a" !f3F
@0(E&E$'$%O" (<" 0.2(7$/8" <0&:%10.-" !cH>"
$/5%012./%5"<0(2"0((%":&/&'5>"["X/-(-" "
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 Case 12
>#<"<"#2)*-'.2'.+26.#2-"8-23.-6+#<)?&,+'-,.82-8)'%2-6",+'-:)23-*3'"#)*-+5)*+,-
5.')"<"#2)2)%@
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%)."G.6&0%2./%"(<"@0(5%)(-(/%$:5*"<(0".7&'1&%$(/"&/-"./-(-(/%$:"%0.&%2./%"(<"%)."2&/-$E1'&0"
'.<%"<$05%"2('&0*"3="
"

Z$8>"!,>!"F""Z0(/%&'"7$.4"!c>!H>,H!H"
"

Chief complaint Radiographic findings

T(" 5O26%(25*" E1%" 0.<<.0.-" <(0" ./-(-(/%$:" "
0.%0.&%2./%"(<"%((%)"3=>"
"

" "
Z$8>" !,>," &/-" !,>3" F" U::'15&'" &/-" E1::&'" 7$.4"
!c>!H>,H!H"

Medical history "

Z$8>"!,>;"F"@.0$&6$:&'"0&-$(80&6)"F"!c>!H>,H!H"
T("2.-$:&'")$5%(0O" "
Tooth 36
Dental history F [/&-.B1&%." 0((%" <$''$/8*" 5)(0%" 0((%"
3=S" :(26(5$%." 0.5%(0&%$(/" 4$%)" <0&:%10.-" <$''$/8"$/"Q"&/-"G"0((%S"" "
-$5%&'" 6&0%*" :&0$.5*" 60.7$(15'O" ./-(-(/%$:&''O" F XK6(5.-"0((%"<$''$/8"G"0((%u"
%0.&%.->" F 9&0$.5"$/"-$5%&'"(0$<$:.5"
F ?6$:&'"A&-$('1:./:O"Q"0((%"
Clinical findings
F L(55"(<"2&08$/&'"E(/."
"
F @?[S";"
D((%)" <8( <5( <;( Tooth 35
9('-" fH" ," If" F A&-$("(6&B1."0.5%(0&%$(/"QUG"
X@D"""HFfH" T(" n.5" T(" F L&2$/&"-10&":&/"E."<(''(4.-"4$%)(1%"
@&'6&%$(/" T(" T(" T(" -$5016%$(/>"
@.0:155$(/" T(" T(" T(" Tooth 34
Q(E$'$%O" T(" T(" T(" F A&-$("(6&B1."0.5%(0&%$(/"GU"
@@G" 3"22" 3"22" 3"22" F L&2$/&"-10&":&/"E."<(''(4.-"4$%)(1%"
" -$5016%$(/>"

" =="
 Diagnosis PA((%"rdV"&/-"4(0C$/8"'./8%)"0&-$(80&6)"4&5"
@1'6&'" lH;>!c"A((%"<$''.-"%((%)" %&C./>"""
@.0$&6$:&'" lH;>IH"9)0(/$:"&6$:&'" "
6.0$(-(/%$%$5"
@.0$(-(/%&'" N$%)$/"/(02&'"'$2$%5"
@?[" ;"P2.5$&'"0((%V"
"

Treatment options
o T(/F5108$:&'"./-(-(/%$:"0.%0.&%2./%>"
o `108$:&'"./-(-(/%$:"%0.&%2./%>"
o XK%0&:%$(/"

Treatment plan
o T(/F5108$:&'"./-(-(/%$:"0.%0.&%2./%S"
0.2(7&'" (<" :&0$.5*" E1$'-" 16" 4$%)" "
Z$8>"!,>I"F"N(0C$/8"'./8%)"0&-$(80&6)"!c>!H>,H!H"
:(26(5$%." %(" &:)$.7." 5&%$5<&:%(0O"
"
&5.6%$:":(/-$%$(/5"
D)." $/5%012./%&%$(/" (<" %)." 0((%" :&/&'" 4&5"
o @0(5%)(-(/%$:"0.5%(0&%$(/""
-(/." 4$%)" _$(0&:.*" &/-" $00$8&%.-" 4$%)" !" J"
Problem list T&U9'" &/-" !+" J" XGD?" %)0(18)" %)."
• ?:)$.7." 5&%$5<&:%(0O" 4(0C$/8" './8%)" j" $/5%012./%&%$(/>+
:&':$<$:&%$(/"(0"5%.6"$/"%)."Q"(0^&/-"G" +
0((%":&/&'5>" ;%&1-4/&-#F+
• `&%$5<&:%(0O"&5.6%$:":(/-$%$(/5"" !> _105*"_$(A&:.*"lF<$'.5*""
Q_S"|;H^H;"!c"22"
Treatment progress QLS"|;H^H;"!c"22"
!c>!H>,H!H" G_S"|"IH^H;"!c"22""
• 9'$/$:&'"&/-"0&-$(80&6)$:".K&2$/&%$(/>" GLS"|"IH^H;"!c"22"
• [/5%012./%&%$(/"%)."0((%":&/&'5" ,> [00$5&<.]"
!!>!!>,H!H" G1%)/&-#F+
• UE%10&%$(/" R6 !J"T&U9'"o"!H"2'+J+!+J"XGD?"o"I"2'+
• D.26(0&0O"0.5%(0&%$(/" ;> @&55$7."1'%0&5(/$:"$00$8&%$(/*""
H3>!H>,H!3"j"3"O.&05"'&%.0" T&U9'*"3"K",H"5>"
• 9(/%0('" E4'.-&-4-#+)%5/&-)%4'F+
I> 9&PU\V,"
Endodontic retreatment <%)$(.-.*+,/##/40F+
First visit
=> 9&7$%"R"&/-"[AQ>"
9'$/$:&'" &/-" 0&-$(80&6)$:" .K&2$/&%$(/" 4&5"
"
:&00$.-"(1%>"A1EE.0"-&2"4&5"-$5$/<.:%.-"4$%)"
Second visit
H*IJ"9\d"$/"+HJ".%)&/('>" T("5O26%(25"5$/:."'&5%"%0.&%2./%>"
U'-" :(26(5$%." <$''$/8" 4&5" 0.2(7.-*" &/-" A1EE.0" -&2" -$5$/<.:%$(/" 4$%)" H*IJ" 9\d" $/"
:&0$.5" 4&5" .K:&7&%.->" " D)." -$5%&'" (0$<$:." 4&5" +HJ".%)&/('>"[AQ"4&5"0.2(7.-"&/-"%)."0((%"
0.E1$'%" %.26(0&0O" 4$%)" :(26(5$%.>" ?::.55" :&/&'"4&5"$00$8&%.-"4$%)"!"J"T&U9'"&/-"!+"J"
:&7$%O" 4&5" 60.6&0.->" R1%%&F6.0:)&" 4&5" XGD?>" ?" 2&5%.0" :(/." 0&-$(80&6)" 4&5" %&C./>"
0.2(7.-"<0(2"%)."0((%":&/&'5":(0(/&''O"4$%)" D).":&/&'"4&5"-0$.-"4$%)"5%.0$'."6&6.0"6($/%5"
R&%.5"R'$--./"E10*"2$-0((%"EO"0(%&0O"T$:C.'F &/-" <$''.-" 4$%)" ?\" 6'15" 5.&'.0" &/-" 81%%&F
D$%&/$12" $/5%012./%5*" &/-" &6$:&''O" 4$%)" 6.0:)&" 4$%)" :('-" '&%.0&'" :(/-./5&%$(/"
:'(0(<(02" &/-" )&/-<$'.5>" L(:&'$M.-" %.:)/$B1.>"
1/$/5%012./%.-" GL" 0((%" :&/&'>" D)." 4(0C$/8" "
'./8%)"4&5".5%&E'$5).-"EO"15$/8"&6.K"'(:&%(0" G1%)/&-#F+
H6 !J"T&U9'"o"!H"2'+J+!+J"XGD?"o"I"2'+
=+" "
 S6 9)'(0).K$-$/." -$F8'1:(/&%." ,J" $/" I" After treatment
2$/"4$%)"1'%0&5(1/-"$00$5&<.>+ "
KA'".-'/(4+
R1%%&F6.0:)&"&/-"?\"@'15](
<%)$(.-.*+.%3'(.-'/(4+
`.&'.-"4$%)"[AQ"
"

"
Prognosis
Endodontic
- Z&7(0&E'."
Tooth
" - Z&7(0&E'."
Z$8>"!,>="F"Q&5%.06($/%"0&-$(80&6)"!!>!!>,H!H"
Restoration
" - Z&7(0&E'."

Control - 3 years follow up

"

"
Z$8>"!,>+"F"Z$/&'"0&-$(80&6)"!!>!!>,H!H"
"
"
Before treatment Z$8>" !,>f" F" 9(/%0('" 0&-$(80&6)" j" 3" O.&05" <(''(4F16"
" H3>!H>,H!3"
"
?%" %)." 3" O.&05" :(/%0('" %)." 6&%$./%" )&-" /("
5O26%)(25>" T(02&'" (0&'" 21:(5&" 4&5"
(E5.07.->" @0(E$/8" -.6%)5" 4.0." 4$%)$/""
/(02&'" '$2$%5>" T(" 6&$/" %(" 6.0:155$(/" (0" %("
6&'6&%$(/":(1'-"E."<(1/->"
@.0$&6$:&'"0&-$(80&6)"5)(4".7$-./:."(<"&6$:&'"
).&'$/8")&-"(::10.-*"@?[","
"

Discussion
" L.&C&8." (<" E&:%.0$&'" .'.2./%5" <0(2" %)." (0&'"
" ./7$0(/2./%" &'(/8" %)." 0((%" <$''$/8" %(" %)."
6.0$&6$:&'"0.8$(/")&5"0.:./%'O"E../"60(6(5.-"
&5" &/" $26(0%&/%" :(/%0$E1%$/8" <&:%(0" %(" %)."
" =f"
6.05$5%./:." (0" -.7.'(62./%" (<" 6.0$&6$:&'"
'.5$(/5" (/" 0((%F<$''.-" %..%)>" `166(0%" <(0" %)$5"
&55126%$(/" :(2.5" 60$2&0'O" <0(2" $/" 7$%0("
5%1-$.5"$/"4)$:)"5.'.:%.-"E&:%.0$&'"(08&/$525*"
'$6(6('O5&::)&0$-." (0" '$6(6('O5&::)&0$-." &/-"
E&:%.0$&'" :.''5" (<" &" 2$K.-" :1'%10." )&7." E../"
(E5.07.-" %(" 6./.%0&%." 0((%" :&/&'" <$''$/85"
:&00$.-"(1%"$/".K%0&:%.-"%..%)"P!V"
" $/%0&:&/&'" 2$:0(E$(%&" 4&5" -.2(/5%0&%.-" $/"
?" 0.%0(56.:%$7." 5%1-O" $/7('7$/8" .K&2$/&%$(/"
(<" <1''" 2(1%)" 0&-$(80&6)5" <0(2" &" 6(('" (<"
6&%$./%5"4$%)"&")$8)"(7.0&''"0&%."(<"6.0$&6$:&'"
'.5$(/5" P3cJV" <(1/-" %)&%" &E5./:." (<" &6$:&'"
6.0$(-(/%$%$5"4&5"5$8/$<$:&/%'O"2(0.":(22(/"
&2(/8" %..%)" 4$%)" 8((-" :(0(/&'" 0.5%(0&%$(/5"
%)&/" 6((0" (/.5*" &/-" %)&%" %)." :(0(/&'"
0.5%(0&%$(/"B1&'$%O"4&5"2(0."$/<'1./%$&'"%)&/"
%)."./-(-(/%$:"<$''$/8"B1&'$%O"(/"%)."60.5./:."
(<" &6$:&'" 6.0$(-(/%$%$5" P,V>" D).5." <$/-$/85"
518.5%" %)&%" '.&C&8." (<" E&:%.0$&" &/-" E&:%.0$&'"
.'.2./%5" <0(2" %)." (0&'" ./7$0(/2./%" &'(/8"
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$/-..-" 6(55$E'." &/-" $5" 6(%./%$&''O" $26(0%&/%"
<(0"%)."(1%:(2."(<"./-(-(/%$:"%).0&6O>"
Q&-$5(/" m" N$':(K" <(1/-" %)&%" .K6(510." (<"
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"
References "
!> A$:1::$"G*"R0s/-)&'"l*"_.08./)('%M"R>" "
@.0$&6$:&'" 5%&%15" (<" 0((%F<$''.-" %..%)" "
.K6(5.-" %(" %)." (0&'" ./7$0(/2./%" EO" "
'(55" (<" 0.5%(0&%$(/" (0" :&0$.5>" U0&'" "
5108.0O" U0&'" 2.-$:$/." U0&'" 6&%)('(8O" "
X/-(-",HHHa"cHS"3I;FIc>" "
,> A&O" \*" D0(6." Q>" @.0$&6$:&'" 5%&%15" (<" "
./-(-(/%$:&''O" %0.&%.-" %..%)" $/" "
0.'&%$(/"%("%)."%.:)/$:&'"B1&'$%O"(<"%)." "
0((%" <$''$/8" &/-" %)." :(0(/&'" "
0.5%(0&%$(/>"[/%"X/-(-"h"!ccIa",fS"!,F "
f>" "
3> `1/-B7$5%" R*" Z$8-(0" G*" @.055(/" `*" "
`Ws80./" Y>" Q$:0(E$('(8$:" &/&'O5$5" (<" "
%..%)" 4$%)" <&$'.-" ./-((-/%$:" "
%0.&%2./%" &/-" %)." (1%:(2." (<" "
:(/5.07&%$7." 0.F%0.&%2./%>" U0&'" `108" "
U0&'" Q.-" U0&'" A&-" X/-(-" !ccfa" fIS" "
f=Fc3>" "
;> Q('&/-.0"?*"A.$%"9*"G&)'./"R*"l7$5%"D>" "
Q$:0(E$('(8$:&'" 5%&%15" (<" 0((%F<$''.-" "
%..%)" 4$%)" &6$:&'" 6.0$(-(/%$%$5>" "
[/.0/&%$(/&'"X/-(-(/%$:"h(10/&'"!ccfa" "
3!S"!F+>" "
I> `$B1.$0&" hZ" W0*" AÅ:&5" [" T>" @('O2.0&5." "
:)&$/" 0.&:%$(/FE&5.-" &/&'O5$5" (<" "
2$:0((08&/$525"&55(:$&%.-"4$%)"<&$'.-" "
./-(-(/%$:"%0.&%2./%>"U0&'"`108"U0&'" "
Q.-" U0&'" @&%)('" U0&'" A&-$('" X/-(-" "
,HH;a"c+SfIFc;>" "
=> Q&-$5(/" `*" N$':(K" LA>" ?/" .7&'1&%$(/" "
(<" :(0(/&'" 2$:0('.&C&8." $/" "
./-(-(/%$:&''O" %0.&%.-" %..%)>" @&0%" 3>" "
[/" 7$7(" 5%1-O>" h" X/-(-" !cffa" !;a" ;IIF "
;If>" "
+> `Ws80./" Y*" \Ä88'1/-" _*" `1/-B7$5%" R*" "
N$/8" l>" Z&:%(05" &<<.:%$/8" %)." '(/8F
%.02"0.51'%5"(<"./-(-(/%$:"%0.&%2./%>"
" +H"
 Case 13
>#<"<"#2)*-'.2'.+26.#2--"8-23.-6+#<)?&,+'-')(32-8)'%2-6",+'-:)23-*3'"#)*-+5)*+,-
5.')"<"#2)2)%@
D)."6&%$./%*"&"I;"O.&05"('-"&5$&/"<.2&'.*"4&5"0.<.00.-"%("%)."G.6&0%2./%"(<"X/-(-(/%$:5"<0(2"%)."
1/-.080&-1&%.":'$/$:*"<(0".7&'1&%$(/"&/-"./-(-(/%$:"0.%0.&%2./%"(<"%)."2&/-$E1'&0"0$8)%"<$05%"
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Z$8>"!3>!"F""Z0(/%&'"7$.4"!3>!H>,H!H"
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Chief complaint Clinical findings

@&$/" &/-" -$5:(2<(0%" 2&/-$E1'&" 0$8)%" 5$-.>" "
?E5:.55" &/-" 5$/15" %0&:%" <$05%" 0$8)%" 2('&0*" ;=>" D((%)" ;8( ;5( ;;(
G1''" 6&$/" &/-" %./-.0/.55" (/" :).4$/8>" D((%)" 9('-" T(" n.5" n.5"
;="4&5"%./-.0"(/"6.0:155$(/"&/-"6&'6&%$(/>" X@D"""HFfH" fH" " ;,"
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Radiographic findings
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Z$8>"!3>,"&/-"!3>3"F"U::'15&'"7$.4"!3>!H>,H!H"

Medical history
T("2.-$:$/."(0"2.-$:&'")$5%(0O>"

Dental history
;=" 60.7$(15'O" ./-(-(/%$:" %0.&%.-" <(0" ;FI"
O.&05"&8("&/-")&7."&"2.%&''$:":0(4/>""
D)." 6&%$./%" 4&5" 0.<.00.-" <0(2" %)." 5%1-./%"
:'$/$:" %(" %)." 56.:$&'$5%" :'$/$:" <(0" ./-(-(/%$:"
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 Tooth 46 • ?:1%.":(/%0('"j"<'&0."16"
F 90(4/"0.5%(0&%$(/" • @0.5:0$6%"@)./(KO2.%)O'6./$:'$/"#""
F ?6$:&'"0&-$('1:./:O"Q"&/-"G"0((%" !H>!!>,H!H"
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F Z10:&%$(/"$/7('2./%" " !,>H3>,H!;"j"3"O.&05":(/%0(''"
F Y/5&%$5<&:%(0O"./-(-(/%$:"%0.&%.-"
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F ?E1%2./%" retreatment
F 90(4/"0.5%(0&%$(/" First visit
F L&2$/&"-10&":&/"E."<(''(4.-"4$%)(1%" 9'$/$:&'" &/-" 0&-$(80&6)$:" .K&2$/&%$(/" 4&5"
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?/.5%).5$&" `.6%(:&$/." !" K" !*f" 2'>" ?::.55"
Diagnosis 60.6&0&%$(/>" A1EE.0" -&2" 4&5" -$5$/<.:%.-"
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Problem list
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 Before treatment Control - 3 years follow up
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After treatment Z$8>" !3>c" j" Z(''(4F16" 6.0$&6$:&'0&-$(80&6)" F"
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D)."&6$:&'"0&-$('1:./%"'.5$(/"4.0."-.:0.&5.-"
&/-*"@?[","
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Discussion
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&E5:.55" 4)$:)" (::105" $/" &" %((%)" 1/-.08($/8"
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- Y/:.0%&$/" D)." :&15.5" (<" .K&:.0E&%$(/" &0." /(%" :'.&0>" ?"
Restoration
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 Case 14
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Chief complaint Clinical findings

D)." 6&%$./%" <..'" 5%0(/8" 6&$/>" XK%0&" (0&'" "
54.''$/8" '.<%" :)..C*" %0$5215" j" 0.-1:.-" D((%)" <5( <8( <=(
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Radiographic findings
"

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Z$8>"!;>!"&/-",>"j"9'$/$:&'"6)(%(80&6)"(<"%).".K%0&"(0&'" Z$8>"!;>3"F"@.0$&6$:&'"0&-$(80&6)"F",3>Hc>,H!H"
54.''$/8*"&/-"$/%0&(0&'"(::'15&'"7$.4",3>Hc>,H!H" "
Tooth 35
Medical history F D)." '&2$/&" -10&" :&/" E." <(''(4.-"
T(" 4$%)(1%"-$5016%$(/"
;%5/&/4%+ Tooth 36
P?2(K$:$''$/"IHH"28V" F A&-$("(6&B1."0.5%(0&%$(/"
F ?6$:&'"0&-$('1:./:O""
Dental history F @?[";"
• ,,>Hc>,H!HS" D)." 6&%$./%" 4&5" %0.&%.-" Tooth 37
&:1%." &%" %)." 9'$/$:" (<" U0&'" `108.0O" &%" F G..6"0&-$("(6&B1."0.5%(0&%$(/"U"
%)."Y/$7.05$%O"(<"U5'(a"$/:$5$(/"(<"%)." F D)." '&2$/&" -10&" :&/" E." <(''(4.-"
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9'$/$:"(<"X/-(-(/%$:5"&%"%)."Y/$7.05$%O" Diagnosis
(<"U5'(" @1'6&'" lH;>!"T.:0(%$:"
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 Treatment options
• T(/"5108$:&'"./-(-(/%$:"%0.&%2./%"
• XK%0&:%$(/"
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D)." 6&%$./%" 4$5)" %(" C..6" %)." %((%)*" &/-"
&::.6%"./-(-(/%$:"%0.&%2./%>"

Treatment plan
o T(/"`108$:&'"./-(-(/%$:"%0.&%2./%"
o 9(/%0('"
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Problem list Z$8>"!;>;"j"9'$/$:&'"6)(%(80&6)",c>Hc>,H!H"
• D0$5215" +
• \.&'$/8"j"E$8"'.5$(/"

Treatment progress
,3>Hc>,H!H"
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Non-surgical Endodontic
treatment
First visit
X/-(-(/%$:" .K&2$/&%$(/*" 6.0$&6$:&'"
0&-$(80&6)5*":'$/$:&'"6)(%(5"&/-"$/<(02&%$(/5"
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"
Second visit +
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 Third visit Before treatment
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:(/." 0&-$(80&6)*" PZ$8" !;>=c" (E%10&%.-" %)."
0((%" :&/&'5" 4$%)" R1%%&6.0:)&" &/-" ?\b" PZ$8"
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G1%)/&-#F+
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Prognosis
Endodontic
- Z&7(0&E'."
Tooth
"" - Z&7(0&E'."
Z$8>"!;>=>"F"Q&5%.06($/%"0&-$(80&6)",=>!H>,H!H" Restoration
" - Y/:.0%&$/"

Control - 1 year follow up

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Z$8>"!;>+>"F"Z$/&'"0&-$(80&6)",=>!H>,H!H"

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Control - 3 1/2 years follow up
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Discussion
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.'$2$/&%$/8" %)." 5(10:." (<" %)." &E5:.55*" %)."
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 Case 15
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Chief complaint Radiographic findings

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Medical history
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Medicines
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Dental history "

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 Tooth 22 Endodontic treatment -
F A((%"<$''.-" pulpectomy
F A&-$("(6&B1."0.5%(0&%$(/" First visit
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Diagnosis Second visit
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Problem list |IH^>H;",;"22"
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Treatment progress - 9&7$%"&/-"[AQ>"
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Fourth visit
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After treatment
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Control - 1 year follow up
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sive cervical resorption: Distribution of po-
sposing factors for patients. From (20). Re-
th permission from Quintessence Publishing.
treatment have also been cited (16, 19). A
222 patients with a total of 257 teeth
varying degrees of invasive cervical resorp-
been analyzed by the author for potential
g factors (20) and the results are summar-
mmatically in Fig. 1.
shows the number of subjects who had
ole potential predisposing factor or a
n of factors. For example of the 33 patients
o had a history of intra-coronal bleaching,
ad bleaching as the sole factor, 17 (7.7%) a
bleaching and trauma, 2 (0.9%) bleaching
dontics and 4 (1.8 %) a combination of
rauma and orthodontics.
potential predisposing factors identified,
cs was the most common sole factor being
n 47 patients (21.2%) with 62 affected teeth
hile other factors, principally trauma and/or
were present in an additional 11 patients
11 affected teeth (4.3%). Trauma was the
st frequent sole factor with 31 patients
th 39 affected teeth (15.1%). Surgery,
involving the cemento-enamel junction
ntified in 13 patients (5.9%) as a sole factor.
surprisingly periodontal therapy including
ebridement showed a low incidence as did
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60(:.55" %)&%" )&5" .K%./-.-" E.O(/-" %)."
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" :&/" 8$7." 15" 7&'1&E'." &--$%$(/&'" $/<(02&%$(/*"
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Z$8" :'&55.5" &/-" .K%./%" (<" :.07$:&'" 0((%" 0.5(06%$(/"
Fig. 2. Clinical classification of invasive cervical resorp-
tion. From (20). Reproduced with permission from
Quintessence Publishing.
&::(0-$/8"%("\.$%).5&0O"P3V"
other factors such as bruxism. No potential predispos-
" Clinical classification
ing factors could be identified in 33 patients (14.9%).
A.8&0-$/8" 4)$:)" %..%)" %)&%" &0." 2(5%"
A clinical classification has been developed by the
author both for research purposes and also to provide a
clinical guide in the assessment of cases of invasive
:(22(/'O" &<<.:%.-*" \.$%.5&0O" P3V" 5)(4.-"
cervical resorption (20). The diagrammatic representa-
tion of this classification is shown in Fig. 2.
%)&%"%)."2&K$''&0O":./%0&'"$/:$5(05":&2."<$05%*"
Class 1 – Denotes a small invasive resorptive lesion near
the cervical area with shallow penetration into dentine.
Class 2 – Denotes a well-defined invasive resorptive
<(''(4.-" EO" 2&K$''&0O" :&/$/.5*" 2&K$''&0O"
lesion that has penetrated close to the coronal pulp
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 Case 16

0&'()*+,-.#<"<"#2)*-2'.+26.#2-+#<-+5)*".*2"67-:)23-'.2'"('+<.-8),,)#(-"8-23.-
6+9),,+'7-,.82-,+2.'+,-)#*)%"'-:)23-*3'"#)*-+5)*+,-5.')"<"#2)2)%
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%)."1/-.080&-1&%.":'$/$:*"<(0".7&'1&%$(/"&/-"./-(-(/%$:"%0.&%2./%"(<"%)."2&K$''&0O"'.<%"'%.0&'"
$/:$5(0*",,>"
"

Z$8>"!=>!"F""Z0(/%&'"7$.4"!;>H,>,H!3"
"

Chief complaint Radiographic findings

T(" 5O26%(25*" E1%" %)." 6&%$./%" 4&5" 0.<<.0.-" "
<(0"./-(-(/%$:"%0.&%2./%"(<"%((%)",,>"
"

"
Z$8>"!=>,"F"_1::&'"&/-"6&'&%$/&'"7$.4"!;>H,>,H!3"

Medical history
;%5/&-#F"?5%)2&"&/-")O6(%)O0($-$52" "
Z$8>"!=>3"F"@.0$&6$:&'"0&-$(80&6)"F"!I>H!>,H!3"
;%5/&-'/(4F"`.00$%$-.*"#./%('$/*"L.7&K$/*" "
Tooth 22
Dental history F `)(0%"0((%"
D((%)" ,," )&5" &" 6(0:.'&$/" :0(4/" &/-" &" F @0.7$(15'O"./-(-(/%$:"%0.&%.-"
2.%&''$:"6(5%>""@0.7$(15'O"./-(-(/%$:"%0.&%.->" F [/&-.B1&%."0((%"<$''$/8*"5)(0%"
Clinical findings F Q.%&''$:"6(5%"&/-"QlF:0(4/"""
Tooth 21
"
F Q$/(0":(26(5$%."<$''$/85"
D((%)" 37( 33( 3<( F L&2$/&" -10&" :(1'-" E.." <(''(4.-"
9('-" n.5" T(" n.5" 4$%)(1%"-$5016%$(/>"
X@D"""HFfH" ,=" fH" !c" Tooth 22
@&'6&%$(/" T(" T(" T(" F L&2$/&" -10&" :(1'-" E.." <(''(4.-"
@.0:155$(/" T(" T(" T(" 4$%)(1%"-$5016%$(/>"
Q(E$'$%O" T(" T(" T("
@@G" !"22" ,"22" !"22" Diagnosis
@1'6&'" lH;>!c"A((%"<$''.-"%((%)"
fc" "
 @.0$&6$:&'" lH;>IH"9)0(/$:"&6$:&'" )(0$M(/%&'"&/-"7.0%$:&'"0.&'$M$/8"$/:$5$(/"4$%)"
6.0$(-(/%$%$5" =" " `160&2$-" IFH" 51%10.5>" @0.5:0$6%$(/" (<"
@.0$(-(/%&'" N$%)$/"/(02&'"'$2$%5" &/&'8.5$:5"&/-"6(5%F(6.0&%$7."$/<(02&%$(/>""
@?[" I" "
"
Treatment options "
• T(/F5108$:&'"./-(-(/%$:"0.%0.&%2./%"
• `108$:&'" ./-(-(/%$:" %0.&%2./%" 4$%)"
&6$:(.:%(2O"4$%)"0.%0(80&-."<$''$/8>"
• XK%0&:%$(/"[26'&/%^E0$-8."
"
D)." 6&%$./%" 4$5).5" %(" C..6" %)." %((%)" &/-"
&::.6%" 5108$:&'" ./-(-(/%$:" %0.&%2./%" 4$%)"
&6$:(.:%(2O"4$%)"0.%0(80&-."<$''$/8>"" "
Z$8>"!=>;"j"9'$/$:&'"6)(%(80&6)"(<".'.7&%$(/"(<"
Treatment plan 21:(6.0$(5%&'"<'&6"j"$/%0&51':1'&0"$/:$5$(/",!>H,>,H!3"
o ?6$:(.:%(2O" 4$%)" QD?" 0.%0(80&-." "
<$''$/8"
o @(5%"(6.0&%$7.":(/%0('""

Problem list
• R$/8$7&'"0.%0&:%$(/"
• A((%"<0&:%10."

Treatment progress
!I>H!>,H!3"
• 9'$/$:&'"&/-"0&-$(80&6)$:".K&2$/&%$(/>"
• G$5:155.-"%0.&%2./%"(6%$(/5>" "
Z$8>"!=>I"j"9'$/$:&'"6)(%(80&6)"(<"0.%0(80&-."<$''$/8"
,!>H,>,H!3" 4$%)"QD?",!>H,>,H!3"
• ?6$:(.:%(2O" 4$%)" QD?" 0.%0(80&-." "
<$''$/8"
,f>H,>,H!3"
• A.2(7."51%10.5"
• @(5%"(6.0&%$7.":(/%0('"
9UTDAUL"="2(/%)5"'&%.0"
• 9(/%0('"

Surgical treatment -
apicoectomy

dO'(:&$/." ?-0./&'$/" ;" K" !*f" 2'>" [/%0&51':1'&0"

<'&6" 4$%)" 2&08$/&'" $/:$5$(/" <0(2" ,!Q" j" ,3G>"
#.0%$:&'"0.'.&5$/8"$/:$5$(/"&%"%)."-$5%&'"&56.:%" "
Z$8>" !=>=" A&-$(80&6)" :(/<$02$/8" 0.2(7&'" (<" 81%%&F
(<" %((%)" ,3>" X'.7&%$(/" (<" 21:(6.0$(5%&'" <'&6" 6.0:)&"$/"%)."0((%":&/&'>"
PZ$8" !=>IV>" U5%.(%(2O" (7.0" %)." E1::&'" 0((%" "
&6$:.5>" 9100.%&8." (<" '.5$(/>" A((%F./-"
0.5.:%$(/"(<"&660(K$2&%.'O"3"22"(<"%)."0((%"
PZ$8" !=>=V>" \&.2.(5%&5$5" 4$%)" <.00$:F51'<&%.>"
[/56.:%$(/" (<" 0((%" <0&:%10." 4$%)" Q.%)O'./"
E'1.*"/.8&%$7."0.51'%5>"Y'%0&5(/$:"60.6&0&%$(/"
(<" 0.%0(80&-." :&7$%O" 4$%)" QD?" P?/8.'15*"
_0&M$'V" PZ$8" !=>I" &/-" !=>+VV>" `1%10$/8" (<"

" cH"
 Prognosis
Endodontic
- Z&7(0&E'."
Tooth
- Z&7(0&E'."
Restoration
- Z&7(0&E'."

Post operative control

D)." 6&%$./%" 0.%10/.-" &<%.0" (/." 4..C" <(0"
51%10."0.2(7&'>"`).")&-"/(%".K6.0$./:.-"&/O"
6(5%F(6"60(E'.25>"D).0."4&5"5(2."$00$%&%$(/"
$/"%)."6&6$''&5"&/-"8$/8$7&'"0.%0&:%$(/>"
"
"
Z$8>"!=>+"Z$/$5)$/8"0&-$(80&6)"

Before treatment

""
Z$8>"!=>f"j"_.<(0."0.2(7$/8"(<"%)."51%10.5"
"

"
"
After treatment Z$8>"!=>c"j"?<%.0"0.2(7$/8"(<"%)."51%10.5"

Control - 6 months follow up

"

"

"

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6&'6&%$(/" :(1'-" E." <(1/->" D)." 0&-$(80&6)"
-$56'&O5"%)&%"%)."'.5$(/"$5").&'$/8>""
Discussion
X/-(-(/%$:" 5108.0O" $5" &" -./%&'" 60(:.-10." %("
%0.&%" &6$:&'" 6.0$(-(/(%$%$5" $/" :&5.5" %)&%" -$-"
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 Case 17
0&'()*+,->#<"<"#2)*-2'.+26.#2-+#<-+5)*".*2"67-"8-23.-6+9),,+'7-')(32-,+2.'+,-)#*)%"'B-
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Z$8>"!+>!"F""Z0(/%&'"7$.4"H=>H3>,H!3"
"

Chief complaint Clinical findings

T("5O26%(25" "
D)." 6&%$./%" <..'" %./-.0/.55" 4)./" 6&'6&%$(/" D((%)" 77( 73(
0.8$("!,"E1::&'>"" 9('-" n.5" T("
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Radiographic findings
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"
Z$8>"!+>,"F"_1::&'"7$.4"H=>H3>,H!3"

Medical history
• \$8)"E'((-"60.5510."
• \$8)":)('.5%.0('"
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Z$8>"!+>3"F"@.0$&6$:&'"0&-$(80&6)"F"H=>H3>,H!3"
Dental history "

!," )&7." &" 6(0:.'&$/" :0(4/" &/-" &" 6(5%*" &/-" Tooth 12
60.7$(15'O" ./-(-(/%$:" %0.&%.->>" D((%)" !," F @0.7$(15'O"0((%"<$''.-"
)&7." (7.0F.016%.-" E.:&15." 2$55$/8" F @(5%"&/-":0(4/"
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F A&-$("(6&B1."0.5%(0&%$(/"Q"G"&/-"_"
F UE'$%.0&%.-"0((%":&/&'" Surgical endodontic treatment –
F L&2$/&"-10&":&/"E."<(''(4.-"4$%)(1%" apicoectomy with retrograd filling
-$5016%$(/>" MTA
Tooth 13 First visit
F @0.7$(15'O"0((%"<$''.-" dO'(:&$/."?-0./&'$/."3"K"!*f"2'>""
F @(5%"&/-":0(4/" `1E2&08$/&'" $/:$5$(/" <0(2" %)." 2.5$&'" &56.:%"
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#.0%$:&'"0.'.&5$/8"$/:$5$(/"&%"%)."-$5%&'"&56.:%"
Diagnosis (<" %)." %((%)" !3>" X'.7&%$(/" (<" %)."
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6.0$(-(/%$%$5" E$(65O*" 0((%" ./-" 0.5.:%$(/" (<" &60(K$2&%'O" 3"
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Treatment options
`1%10$/8" (<" )(0$M(/%&'" &/-" 7.0%$:&'" 0.&'$M$/8"
• XK%0&:%$(/"$26'&/%^E0$-8."
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./-(-(/%$:"0.%0.&%2./%" Postoperative information
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&6$:(.:%(2O" &/-" 0.%0(80&-." <$''$/8" 2.&510.5>"
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Treatment plan "
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Z$8>"!+>;>"9'$/$:&'"6)(%(80&6)*"$/:$5$(/"!;>!!>,H!3"
Problem list "
• A.%0&:%$(/"(<"%)."8$/8$7&"
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:(&81'&/%"2.-$:&2./%"Q&0.7&/"
"

Treatment progress
H=>H3>,H!3"
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QD?"
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• @(5%"(6.0&%$7.":(/%0('"
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cI" "
 Prognosis
Endodontic
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Tooth
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Restoration
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Biopsy diagnose
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Suture removal and post

operative control
"
Z$8>"!+>="j"@.0$&6$:&'"0&-$(80&6)"(<"%)."0.%0(80&-"<$''$/8" D4("-&O5"&<%.0"%)."5108.0O"%)."6&%$./%":&''.-"
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Before treatment (<"%)."<&:.>"PZ0(2"%).".O."&/-"-(4/"%("/.:C"
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After treatment
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Discussion
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Radiographic history
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Medical history
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Treatment options
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Problem list
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Treatment progress
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Postoperative information
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Post operative control

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Control – 3 months follow up

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Biopsy diagnose
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Before treatment
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Discussion
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Prognosis [/" %)$5" :&5." %)." (6%$(/" 4&5" ./-(-(/%$:"
Endodontic
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Reference
!> Q&//(::$" Z*" @.01" Q*" `).0$<<" Q*" 9((C"
A*" @$%%" Z(0-" DA>" D)." $5%)215.5" (<" %)."
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 Case 19
0&'()*+,->#<"<"#2)*-2'.+26.#2-+#<-+5)*".*2"67-"8-23.-6+9),,+'7-')(32-8)'%2-6",+'-:)23-
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2('&0*"!="
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Z$8>"!c>!"F""Z0(/%&'"7$.4"H3>!H>,H!3"
"

Chief complaint Dental history

`O26%(25" &<<.:%.-" EO" 6&'6&%$(/" !=>" Z(''(4F @0$(0" ./-(-(/%$:" %0.&%.-" &%" %)."
16":(/%0('"&<%.0"./-(-(/%$:"%0.&%2./%"&%"%)." 1/-.080&-1&%.":'$/$:"&%"%)."Y/$7.05$%O"(<"U5'("
5%1-./%" :'$/$:" 5)(4.-" <&$'.-" ./-(-(/%$:" ?60$'",H!!>"
%0.&%2./%>" 9(26(5$%."0.5%(0&%$(/"
" "

Clinical findings
"
D((%)" 75( 78( 7=(
9('-" n.5" T(" n.5"
X@D"""HFfH" 3c" fH" 3I"
@&'6&%$(/" T(" n.5" T("
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Radiographic findings
"

"
Z$8>"!c>,"&/-"!c>3"3"F"_1::&'"&/-"(:'15&'"7$.4"
H3>!H>,H!3"
"

Medical history
T("2.-$:&'")$5%(0O"

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!HI" "
 Z$8>"!c>3"j"@.0$&6$:&'"0&-$(80&6)"(<"%((%)"!=" @.0$(-(/%&'" N$%)$/"/(02&'"'$2$%5"
H3>!H>,H!3"
" @?[" ;"&/-"I"

Radiographic history Treatment options

" F XK%0&:%$(/"
F X/-(-(/%$:"0.%0.&%2./%"
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Treatment plan
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Problem list
• @(55$E'."0((%"<0&:%10."
• ?/&%(2OS"5$/15"2&K$''&0$5"

Treatment progress
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Tooth 15 "
F L&2$/&"-10&":&/"E."<(''(4.-"4$%)(1%"
Surgical endodontic treatment –
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apicoectomy with MTA retrograde
Tooth 16
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Z$8>"!c>f"j9'$/$:&'"6)(%(80&6)"(<"0.%0(80&-."<$''$/8"4$%)"
QD?",c>!H>,H!3" Postoperative information
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Biopsy diagnose
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After treatment :.''5" &55(5$&%.-" %(" :)0(/$:" &6$:&'"
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Prognosis
Endodontic
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Tooth
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Restoration
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Control - 4 months follow up

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Post operative control
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Discussion
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Reference
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