How to Prepare 2nd RCT Procedure?

A 30-year-old woman presents to clinic with a large palatal swelling (Fig.1,2).  In fact the tooth #7 is necrotic with a periapical radiolucency (Fig.2 arrowheads).  RCT is initiated; note the curved canal and file (Fig.3).  To reduce the large lesion, Calcium Hydroxide paste is placed in the enlarged canal (Fig.4 *).  In a month, the palatal lesion decreases (Fig.5).  After rebridement of the canal, Calcium Hydroxide paste is re-applied.

Since the tooth is nonvital, the 2nd RCT procedure does not require local anesthesia for rubber dam placement.  Prepare the largest size of hand file used last visit (read the note).  In this case, remind the busy doctor of prebending the file and of the working length.  Prepare Calcium Hydroxide paste with a large gauge needle.

When this patient returns with improvement of symptoms, RCT will be finished.  In fact the swelling relapses a month later (Fig.6).  After discussion of possible cyst enucleation and increase in debridement from 30/.04 to 40/.06, a master cone of 40/.06 is inserted (Fig.7) and RCT is finished (Fig.8).  Although the patient reports relapse of swelling, the palate looks normal and bone density increases 7 months postop (Fig.9).

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Xin Wei, DDS, PhD, MS 1st edition 04/14/2017, last revision 01/05/2018