A Short Case Study: My Mistake on Tooth No. 31!

Rico D. Short, DMD


I hope all is well with your health and practice. I wanted to share this case with you. I like sharing my successful cases as well as my failures. This one was on me.

A patient came in with pain on tooth No. 31. It had a large carious lesion and a large periapical pathology (Figure 1). The diagnosis was necrotic pulp with acute apical abscess. I performed endodontic treatment in two visits with calcium hydroxide and brought the patient back for completion (Figure 2).


Figure 2. I performed endodontic treatment over the course of two visits with calcium hydroxide.

Figure 3. During treatment, I had perforated the mesial root.
Figure 4. Using bioceramic gutta percha and bioceramic sealer, I repaired and sealed the perforated area. Figure 5. Six months later, the tooth was fully restored.

However, there was bleeding in the mesial root. I performed the conefit, and I perforated the mesial root! How did this happen? I don’t know (Figure 3).

I used bioceramic gutta percha and bioceramic sealer from Brasseler USA to repair and seal the perforated area as well as the other canals. Notice a little overfill on the distal (Figure 4). The patient returned in six months with the tooth restored and asymptomatic with nice healing (Figure 5). The overfill on the distal has been resorbed too.

Things happen to the best of us as we practice dentistry. Not every case will go as perfectly as planned. It’s how we respond to the case, know how to repair the area, or properly refer the case to someone who does know how to fix things that makes use great providers. Fortunately, I was on the winning side of this one. This tooth should be fine for a long, long time.

Also, I will be speaking at the 2020 ADA Annual Meeting in Orlando, Florida. Hope to see you there! We have new 3-D CBCT technology, and I will lecture about its use in endodontics.


Dr. Short attended the Medical College of Georgia School of Dentistry to attain a DMD degree in 1999. In 2002, he earned his postdoctorate degree in endodontics from Nova Southeastern University and then became a Diplomate of the American Board of Endodontics in 2009. Dr. Short is an expert consultant in endodontics to the Georgia Board of Dentistry, author, speaker, and assistant clinical professor at the Dental College of Georgia in Augusta. His private practice, Apex Endodontics PC, is located in Smryna, Ga. He can be reached at dr.short@yahoo.com.

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