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Endo Questions for the RWE Faculty:

In this area, users are encouraged to ask questions from the RWE Faculty regarding Endodontics in General and the EndoSequence Technique.

Endo Questions for the RWE Faculty:: Painless in apical lessions

Missing

Joined: June 2016

Rank: Rookie

Posts: 5

#1
Hello, I want to ask how to manage a painful instrumentation in a first lower molar, only in the mesiobucal root, where is located a periapical lesion.
 
My procedure was:

- I block the alveolar nerve ( 1 carp. articaine+epinephrine 4%), and one infiltrative shot in vestibular area.
- I could clean Distal and ML roots without any problem, so I supposed that I get pulpal anesthesia, measuring with my AL, in a crown-down technique. 
- But everytime that I tried to clean the MB root the patient feels discomfort, and my AL don´t show that I arrive to the apex. I use crown-down tech., irrigate with NaOCl 5´25%, and EDTA 17%, and intraroot anesthesia.
Thanks, and congratulations for your work








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Joined: November 2013

Rank: Faculty General

Posts: 43

#2
In reply to Ramon Gonzalez This is due to sprouting of the nerve fibers at the apex. You may have also had accessory innervation. If you already did a buccal infiltration and it didn't work, then instrasulcular, followed by Lingual infiltration are additional options. If that doesn't work you move to intraosseous. You want to get enough anethsetsia long enough that you can quickly do your pulpectomy in that root. Intrapulpal won't work at that point.