بسم الله الرحمن الرحيم

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

2. First case • Patient Personal Data Age: 60 years old Sex: male Nationality: Saudi • (Patient referred from Resto clinic for evaluation tooth #6) • Chief complaint: I had swelling in my gum since one week .

3. Medical History • WNL • Dental history : • Multiple restorations & 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 Pulpal : Necrotic pulp Periapical : Chronic Apical Absccess Periodonta: Generalized gengevitis Prognosis good Treatment plan Non surgical root canal treatment

8. 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.

9. Intra oral sinus tract • In 1961 Bender & Seltzer reported that they found sinus tract to be line with granulation tissue not epithelium • ( Harrison and Larson in1976 )found only 1 of 10 ST lined with epithelium. The other lined with granulation tissue .

10. Intra oral sinus tract • (Baumgartner et al 1984) 20 of 30 did not have epithelium. • The remaining 10 had some epithelium that extended from the oral mucosa surface to the periradicular lesion.

11. The sinus tract usually disappears in 5 to 14 days after the root canal system has been thoroughly cleansed. Spear KL, Sneddon PJ and Perry HO. 1983

12. . Bender &Seltzer 1961 • Clinical observation reveal that sinus tract close spontaneously after the first or second treatment in an interval of one to two weeks • Surgical intervention is not necessary

13. Grossman 1963 ST requires no special treatment and will close as soon as the root canal is adequately cleansed .

14. Measurements

15. Treatment

16. After obturation Pre-operative One week recal

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

18. Medical history : • WNL • Dental history : • Multiple restorations.

19. (Objective) examination:

20. Suspected teeth :

21. Radiographic Findings :

22. DiagnosisPulplesscanal+CPPPrognosisgood Diagnosis Pulpal:- Pulpless canal Periapical:Chronic Periradicular Periodontitis Periodontal: Generalize mild periodontitis with localized moderate periodontitis Prognosis Good Treatment plane Non surgical root canal treatment

23. Studies of Apical Canal Configurations for the Mesial Root of the Mandibular First Molar References 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 of Apical Canal Configurations for the Distal Root of the Mandibular First Molar References 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.

25. Incidence of four canals in root-canal-treated mandibular first molar in a Saudi Arabian sub-population • The occurance of four root canals in the mandibular first molar of a Saudi Arabian sub-population was 57.76 % . Al-Nazhan 1999

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

27. Measurements Distal angulation Straight Angulation

29. Best success for tx necrotic cases with apical periodontitis are when the obturation ends within 0-2 mm of radiographic apex (= 94%).Sjogren (1990) Best Success Observed with CBCT is when filling is Adequate & at 1mm. Levelfrom radiographic apex .Moura et al 2009JOE