RESUMEN
INTRODUCTION: Orofacial pain diagnosis is a difficult process. This article reports the case of a 38 y.o. patient experiencing severe acute facial pain of dental origin initially diagnosed as non odontogenic. CASE REPORT: The patient consulted at the dental emergency department for severe and frequent neuropathic-like paroxysmal pain attacks located in the anterior right maxilla. The pain fulfilled the ICHD3 criteria for Trigeminal Neuralgia (TN) of the right maxillary branch (V2) and responses to sensitivity tests were ambiguous due to severe allodynia. After one week of carbamazepine treatment (600mg/day), the patient was pain free except for a slight mechanical allodynia on tooth #12. Sensitivity tests revealed pulp necrosis and tomodensitometry revealed a rare developmental abnormality, dens invaginatus. Root canal treatment was performed. RESULTS: No recurrence of the pain was noted after 18 months without any medication. CONCLUSIONS: Inflammatory pulpal pain may mimic TN, misleading experienced clinicians. Key words:Dens in dente, neuropathic pain, necrosis, diagnosis, atypical pain, endodontics.
RESUMEN
INTRODUCTION: The purpose of this study was to compare the speed of removal of root canal filling material and re-establishment of apical patency in root canals filled with a tricalcium silicate-based sealer (BioRoot RCS [BRCS]; Septodont, Saint-Maur-des-Fossés, France) versus a zinc oxide-eugenol sealer (Pulp Canal Sealer [PCS]; Sybron Endo Kerr, Orange, CA) and to analyze the effect of the operator's experience. METHODS: One hundred twenty root canals of 40 Dentalike dental simulators (Dentsply Sirona, York, PA) were shaped with a WaveOne (Dentsply Sirona) reciprocating file using short 3-mm strokes. Root canals were obturated using a single gutta-percha cone and either BRCS or PCS. Samples treated either with BRCS or PCS were equally dispatched between experienced practitioners and junior practitioners. The time required to remove root filling material and establish apical patency was recorded for each root canal. Samples were compared according to the sealer used and the practitioner's experience (Mann-Whitney test). RESULTS: One hundred fifteen root canals were successfully retreated. No differences in the time required to remove the filling material were observed between the 2 materials for mesiobuccal or distobuccal canals (P > .05). In contrast, the procedure was longer for palatal canals filled with BRCS compared with PCS (79.10 vs 182.45 seconds, P < .01). Experienced practitioners took significantly less time than junior practitioners (P < .05). CONCLUSIONS: BRCS can be successfully removed from root canals as quickly as a zinc oxide-eugenol sealer in both mesiobuccal and distobuccal canals but not in palatal ones. The duration of the procedure was affected by the operator's experience independent of the filling material used or the canal type.
