A 56 year old Caucasian female presented lingering pain to cold and pain to bite. The patient was unable to sleep because she was in so much pain from tooth #30.
Pulpal diagnosis: Symptomatic irreversible pulpitis.
Periapical diagnosis: Symptomatic apical periodontitis.
Procedure performed: Non-surgical root canal therapy.
Diagnosing this tooth was very interesting because the patient’s pain was caused by a vertical crown fracture emanating from the distal restoration. This fracture was observed and removed clinically under the surgical microscope.
Upon looking at the radiograph it does not appear that such a small restoration would cause so much discomfort. This case was challenging because the patient was extremely difficult to anesthetize. The tooth was still sensitive to cold until an intraosseous injection was given.
This case was unique because of the roots which measured at 25 mm in length. Also notice the curved mesial canals and the lateral canal mid root pictured below.