#18 Endo, initial endo failed, retreat within 1 year. Good outcome.

Okay, I realize it's been a while since I posted any videos. It's been more than a month, I'm sorry. It's been a busy month. So today we're going to talk about this case that's in front of us. This is a patient who I presented with some pain on her lower left, tooth number 18. So the issue that we had with her, or that she had rather, was real intense aching, throbbing, hot and cold sensitivity coming from tooth number 18. So pulp testing, percussion testing, all that revealed that this tooth needed a little TLC. So we decided that we were going to go ahead, sorry that camera's shifting, we were going to go ahead and do a root canal and a crown for her. And ultimately that turned out really well, at least I thought it did. So moving to the next x-ray here. Here are some of the more specific x-rays. Again, you can't really see anything going on around the root tip. Maybe perhaps a little bit of, you know, widening the ligament. Maybe some radiolucency there that just wasn't really clear. Anyway, we ultimately decided based on her symptoms to go ahead and move forward with a root canal because of her symptoms primarily. So here's the post-op, the immediate post-op with the root canal and the crown. This crown incidentally, let me change the color here, this crown right here, got a serosmart style crown. So anyway, the root canal turned out really, really well. You know, it looks like we filled up all the apices. We got a little extra spurt of sealer there out the root tip. Looks pretty good for all intents and purposes. So what I like to do is, you know, in these emergency visits, the final thing that I like to say to patients after we've talked about post-op and give them pain control medications if needed, is I'd like to get you back for a comprehensive exam to make sure that we're not missing anything else. And we want to make sure that everything's on track to keep your mouth healthy and prevent you from having some situations like this. So she came back for a full exam, right? And when we took the panoramic, and it was several months, I want to say six months, maybe as long as a year, we're seeing this. And you can see, I mean, there's obviously a radiolucency there, which is much more significant, much more visible than the previous, the pre-op x-ray. So, you know, what do we do about this? How do we treat that? Well, since I had done the root canal, and it had been, it must have been less than a year, it had been less than a year, I told her that we'd go ahead and retreat it. So, you know, what I had used to treat this initial root canal was, you know, wave one with master cone and gutter pergium, some lateral cones if needed. But usually I just use a single master cone and use a lot of sealer after it's disinfected to make sure I compact it. I heat it up and I compact it backward down into the canal structure to make sure it's nice and dense. Boy, that camera's shifting, I'm sorry. So I felt like it looked pretty good. However, you know, post-op, a year later, we've got a radiolucency. So we retreated it. And this is the immediate post-op of the retreat. So my process for retreats is basically the same as for initial treats, initial root canal treatments, which involves, of course, numbing the patient, making sure they're comfortable, accessing into the canal structure, and then using, you know, whether it's Gates-Glinton files, instruments to clear out, using hand files and disinfectants and solvents as appropriate. And then I like to soak it in the sodium hypochlorite, making sure not to overextend and get any out the apex, out in this area. And then I also like to soak it in BioPure on any retreat. Sometimes if you get a significant abscess, I know the literature points to, if you have a very large abscess that's visible in a necrotic tooth, there's a two-step process that's recommended, which would involve, you know, calcium hydroxide and allowing the patient to soak for a couple of weeks. So we ultimately, we opted to go ahead and complete it the same day. I let her soak in BioPure for maybe a half an hour or so to get this end resolved. And in the end, she came back just yesterday, this is why it's on my mind, for a post-op and a continuing care exam. And we did a post-op on this tooth. And here is the post-op. It's obviously got some healing happening. And this is, I want to say this is right at six months. So we've got a good amount of healing that's filling in where that giant abscess was, or radiolucency, I should say, was. And as you can see the retreat on the end, it looks good. It looks very good. I don't think we found an extra canal, but you can see that obviously these are much wider than they were before. You know, normally what I go to on an initial root canal is a size 25, weight of one, the primary 25 with a variable taper. This is probably a 45, the white, the size that's white. Apparently my stand isn't wanting to hold this camera very well, I'm sorry. But yeah, so in the end, the outcome is very positive. I'm hopeful that this tooth will remain issue-free. We do just have this access filled with composites since this is a CeraSmart, which is a, you know, reinforced composite material. We just have it filled with composite and it's still adapted very well. You know, I made sure to silenate the internal surface of the crown so that it bonds and holds appropriately to that bonding resin. But everything looks good. She's still symptom-free. Hopefully it'll stay that way. Anyway, good case. You know, my philosophy, my policy has always been one of trying to defer to the patient from the standpoint of charging them less than the absolute maximum, if that makes any sense. I want to make sure that my patients feel like I'm taking care of them. And if we continually, oh, you came in for a root canal and then, you know, four months later, five months later, your root canal's failing, we need to redo it. Now, if there's an indication, there's a reason for it that's rational and ethical, sure. You know, definitely you can justify the charges. But I've found if I can, like in this situation, if I can retreat this root canal for this patient without charging her, then sometimes that goodwill that, you know, I invested in by not charging the patient goes a lot further than that extra few hundred dollars that the office would have harvested from, you know, re-billing or charging the patient. And oftentimes the patients ask, well, you know, insurance won't pay for this. Why are you doing this? And it creates some challenges. So reasonably, and I'm not trying to say this should happen in every case, but reasonably, we want to do our best to try to save the patient's money. Because like I said, the goodwill that we're saving ends up, the goodwill that we're creating ends up being a great marketing investment, if you will. Certainly that's not the reason we do that. But it ends up being, you know, having many, many benefits from the standpoint of preserving a positive relationship. And yeah, the patient's going to come back and they may talk about it. You know, I had to have this re-treatment done, but the doc didn't charge me for it and all this good stuff. Anyway, so that's my thought for the day. Again, it was a good case. You know, I feel like we did this patient a good service, you know, starting out and getting her out of pain here initially and then completing the root canal and then redoing that with some really positive, you can see the comparison there, really positive results there. So again, thanks for watching. If you have any preferences, any suggestions, any recommendations as far as what you'd like videos about, I'm happy to entertain those suggestions. Please go ahead and message me and share and like. Thanks again. Bye.