Endodontic Cases

From time to time, cases from faculty and postgraduate students will be featured. Here is a case from Dr. Richard Munaretto, first-year postdoctoral student. All images are the property of Dr. Munaretto and cannot be reproduced without his permission.

Case History: A 14 year-old African-American female presents to the Endodontic Clinic with the complaint of a “pimple” which drains intermittently on her left cheek. The patient relates that it has been present for at least five months and has been treated by several courses of antibiotics. To date, the pimple has not resolved and is currently not draining.

Subjective History: The patient is asymptomatic and denies any history of pain upon mastication or with temperature changes.

Objective Findings: The patient appears to be a well nourished 14 year-old African-American female who denies any medical problems or allergies. Extraorally, her face appears symmetrical with no noticeable swelling(s). There is a pustule like lesion present on her left cheek (see pictures 1, 2 & 3). Palpation reveals no swellings or palpable nodes in the head and neck area. The patient has numerous restored teeth with amalgam restorations present. On the lower left quadrant, teeth numbers 18,19 and 20 have amalgam restorations with #19 having a deep mesio-occlusal amalgam (see pictures 4 & 5). There is no redness or swelling evident that is associated with any of the soft tissues in this quadrant. Pulpal evaluation reveals that teeth numbers 18, 20 and 30 respond vitally and within normal limits to both thermal and electric pulp testing. Tooth #19 did not respond to “Endo-Ice” and the electric pulp tester went to 80 without a response. All teeth in the lower left quadrant were negative to percussion and palpation. There is a history of an amalgam being placed in #19 approximately six months ago. Radiographic exam displays a 3 mm radiolucency (pictures 4 & 5) between the distal root of #19 and the mesial root of #18.

Diagnosis: #19 necrotic with chronic periapical abcess.


Treatment: Root canal therapy #19 (see figures 6, 7, & 8) with full coverage restoration.

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Picture 8

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A case by Dr. Mohamad Fayad

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