A patient came in with pain on tooth No. 18. The diagnosis was a necrotic pulp with acute apical periodontitis. The inferior alveolar nerve was very close to the apex of the distal root (Figure 1). Apical control of instrumentation, irrigation, medication, and obturation were critical (Figures 2 and 3). Such patients could get paresthesia in this area if it’s violated. The following factors can help with apical control:
- Apex locators;
- A side-vented irrigation needle;
- A good cone fit with tugback;
- A cone fit radiograph;
- Loose calcium hydroxide placement—don’t bend the tip and then push!
Also, use sealers that can resorb like Kerr’s EWT or zinc oxide eugenol-based sealer. Resin sealers like Dentsply Sirona’s AHplus and Brasseler USA’s Bioceramics will not resorb, and they can cause problems if they are extruded in the inferior alveolar nerve. And finally, don’t go for “puffs,” and don’t “over pump” the gutta-percha with sealer.
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Figure 2. The post-op x-ray shows the completed root canal in an inverted view. |
Figure 3. The post-op x-ray shows the completed root canal in the normal view. |
Keep root canaling!
Dr. Short attended the Medical College of Georgia (MCG) School of Dentistry to attain a DMD degree in 1999. In 2002, he earned his postdoctorate degree in endodontics from Nova Southeastern University and then became a Diplomate of the American Board of Endodontics in 2009. Dr. Short is an expert consultant in endodontics to the Georgia Board of Dentistry and assistant clinical professor at the Dental College of Georgia in Augusta. He is endorsed by the American Association of Endodontists speakers bureau. His private practice, Apex Endodontics PC, is located in Smryna, Ga. Dr. Short also has authored a book, Getting to the Root of Your Problem: 365 Days of Inspirational Thinking. He can be reached at dr.short@yahoo.com.
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