بسم الله الرحمن الرحيم

1. بسم الله الرحمن الرحيم Presented by Dr.HusainKeylani [SSC-Dent(Endo)], R1 Endodontic case presentation

2. First case • Patient Personal Data Age: 60 years old Sex: male Nationality: Saudi • Chief complaint: ( I have swelling in my gum).

3. Medical History • Past :- NAD • Current :- NAD • Dental history : • Multiple fillings & missing teeth.

4. Clinical evaluation Extra oral examination WNL Intra oral examination Sinus tract bucal to tooth # 6

5. Clinical evaluation

6. Radiographic findings

7. Diagnosis Necrotic pulp+CPA Prognosis good Treatment plan Non surgical root canal treatment

8. There was general agreement that 30% to 50% mineral loss is required before radiographic rarefaction is visualized in osteoporotic bone B. Bender (April 1982)

9. Studies of Apical Canal Configurations for the Maxillary Canine 1- Oral Surg Oral Med Oral Pathol Oral RadiolEndodon 58:589, 1984. 2- Oral Surg Oral Med Oral Pathol Oral RadiolEndodon 33:101, 1972 3- J Endodon 21(4):200, 1995.

10. Intra oral sinus tract • A chronic endodontic infection will drain through an intraoral communication to the gingival surface known as a sinus tract Baumgartner et al 1984. In 1961 Bender & Seltzer reported that they found sinus tract to be line with granulation tissue not epithelium

11. Intra oral sinus tract • ( Harrison and Larson in1976 ) found only 1 of the 10 sinus tracts they studied were lined with epithelium. The other nine specimens were lined with granulation tissue • (Baumgartner et al 1984) found 20 of 30 specimens did not have epithelium that extended beyond the level of the surface mucosa rete ridges. The remaining ten specimens had some epithelium that extended from the oral mucosa surface to the periradicular lesion.

12. Measurements

13. Treatment

14. During restorative treatment Pre-operative One week recal

15. Second case • Patient Personal Data Age: 36 years old Sex: male Nationality: Saudi • Chief complaint: • Referred from prostho clinic to do RCT#30

16. Medical history : • Significant medical history: N.A.D • History of allergic reactions: None • Dental history : • Multiple fillings.

17. (Objective) examination:

18. Suspected tooth :

19. Radiographic Findings :

20. DiagnosisPulplesscanal+CPPPrognosisgood Diagnosis Pulpal:- Pulpless canal Periapical:Chronic PeriradicularPeriodontitis Periodontal : Generalize mild periodontitis with localized moderate periodontitis Prognosis Good

21. (Treatment Plan)

22. Studies of Apical Canal Configurations for the Mesial Root of the Mandibular First Molar 1- Oral Surg Oral Med Oral Pathol Oral RadiolEndodon 58:589, 1984. 2- Oral Surg Oral Med Oral Pathol Oral RadiolEndodon 33:101, 1972 3- J Endodon 21(4):200, 1995. 4-Int Endodon J 34:359, 2001. -

23. Studies of Apical Canal Configurations for the Distal Root of the Mandibular First Molar 1- Oral Surg Oral Med Oral Pathol Oral RadiolEndodon 58:589, 1984. 2- Oral Surg Oral Med Oral Pathol Oral RadiolEndodon 33:101, 1972 3- J Endodon 21(4):200, 1995. 4-Int Endodon J 34:359, 2001.

24. Studies showing reduced success of NSRCT with apical periodontitis:

25. Measurements

26. Treatment

27. - Best success for tx necrotic cases with apical periodontitis are when the obturation ends within 0-2 mm of radiographic apex (= 94%). • underfills are less successful (68% when filled > 2mm from apex) • and overfills are less successful (76%). Sjogren (1990)