#31 with a Periapical Lesion

Despite Abscess, QMix & EndoActivator Successful

Clinician: Dr. Aneel Belani, DDS, Aurora, IL

Description of the tooth: Lower molar #31 of a 52-year-old female patient

Diagnosis: Pulpal necrosis with chronic periradicular abscess

The situation: Dr. Belani’s patient sought his second opinion in hopes of saving her lower molar. She had a crown placed more than five years ago on teeth #29-31 and a history of discomfort around tooth #31, which worsened two months earlier. The patient’s dentist deemed the tooth fractured and non-restorable.

Dr. Belani’s clinical evaluation revealed a draining fistula on the buccal aspect of tooth #31. The tooth had no response to cold, no pain to percussion, 7-8 mm probing depths on its distal aspect, and pain to palpation. Other teeth in the quadrant tested normal. With his diagnosis of pulpal necrosis with chronic periradicular abscess, Dr. Belani advised the prognosis was guarded, but he was willing to try to save the tooth for his patient.

The procedure: The patient was anesthetized using two carpules of 2% lidocaine for IANB and two carpules of septocaine for long buccal infiltration. The tooth was isolated with a rubber dam and accessed under an operating microscope using long shank round burs and an Endo-Z bur for refining the access cavity walls.

After determining working length with a Root ZX II apex locator, Dr. Belani instrumented the canals with X-Gates and a combination of ProTaper Universal and Vortex Blue files with full-strength sodium hypocholorite. QMix 2in1 irrigating solution was then activated with an EndoActivator as a one-step final rinse to remove smear layer and kill bacteria.

Calcium hydroxide was placed and the root canal was temporized with TERM temporary.

On the second appointment, the calcium hydroxide was rinsed out and the canals re-instrumented. QMIX 2in1 irrigating solution was again activated in the canals. The canals were filled using warm vertical condensation with System B and Calamus backfill.

Outcome: At her six-month follow-up appointment, the patient was asymptomatic with clear evidence of healing.

Aneel Belani, D.D.S., of Aurora, IL, earned his certification from the American Board of Endodontics, and at age 28, he was the youngest endodontist to do so. Belani is an endodontist in private practice with Elite Dental Specialists. Becoming a Board-Certified Diplomate is the highest status an endodontist can achieve.

Belani graduated from Waubonsie Valley High School in 2000. He holds a degree in biology from the University of Illinois in Urbana-Champaign and graduated from the West Virginia University School of Dentistry in 2008. After completing residency in 2010, Belani returned home to begin private practice in Aurora. He also is a part-time faculty member in the Endodontic Department at University of Illinois School of Dentistry in Chicago.


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