Endodontics

A 29-year-old has severe spontaneous pain from a lower molar; cold provokes lingering pain, percussion is tender, radiograph is normal.

A 35-year-old returns 24 hours after starting RCT with severe biting pain; no swelling, afebrile.

A 17-year-old with an immature maxillary incisor has a small carious pulp exposure; tooth is asymptomatic to percussion.

A 42-year-old presents with swelling adjacent to a mandibular molar and fever 38.5°C; tooth is necrotic with fluctuant buccal swelling.

A sinus tract is noted on attached gingiva over a maxillary lateral incisor; cold negative, percussion tender, radiolucency at apex.

A 31-year-old with deep caries has intense pain to heat that is relieved by cold; percussion mildly tender.

During access on a mandibular molar, sudden bleeding and NaOCl bubbling occur on the furcal wall.

A file separates in the MB canal of a maxillary first molar at mid-root; canal was previously patency-checked and irrigated.

A 54-year-old has a sinus tract tracing to the mid-root of a mandibular molar; history of previous RCT; CBCT shows vertical root fracture.

A 26-year-old with symptomatic irreversible pulpitis asks for antibiotics for pain before a trip.

While irrigating with 5% NaOCl, the patient experiences sudden severe pain, swelling, and ecchymosis.

A maxillary canine tests vital with lingering cold pain; percussion negative; caries approximates pulp.

A 45-year-old molar has heavy calcification; canal orifices are not visible after standard access.

An apex locator shows sudden “beyond apex” readings; rubber dam seal is intact; the canal is full of exudate.

A 39-year-old has symptomatic apical periodontitis after a high composite restoration placed yesterday; cold is normal.

A necrotic mandibular molar with swelling is accessed; pus drains through the canal; patient is afebrile.

A 12-year-old avulsed a permanent maxillary central incisor 40 minutes ago; stored in milk; closed apex.

A 9-year-old avulsed a primary incisor 20 minutes ago; parent brings the tooth.

A 30-year-old with deep caries has non-lingering cold response and no tenderness to percussion.

A mandibular molar shows continuous canal curvature; clinician wants to reduce ledging risk.

After instrumentation, smear layer persists; clinician wants better sealer adaptation.

A 52-year-old with retreatment needs a post; how much apical gutta-percha should be retained?

A 37-year-old presents with invasive cervical resorption on a maxillary incisor; tooth is asymptomatic.

During obturation, sealer extrudes slightly beyond apex in a tooth without symptoms.

A mandibular molar develops a ledge at working length; the file will not negotiate apically.

A 41-year-old complains of severe pain after RCT obturation; no swelling or fever; occlusion is high.

A tooth with internal resorption shows a well-defined ovoid radiolucency continuous with the canal; cold is negative, percussion mildly tender.

A patient on warfarin (INR 2.5) needs emergency pulpectomy for acute pain.

A 33-year-old has persistent exudation preventing dry canal at working length.

A maxillary first molar requires locating MB2.

A 24-year-old with symptomatic irreversible pulpitis cannot obtain profound anesthesia with IAN block alone.

A 58-year-old has a previously treated tooth with new apical radiolucency; sinus tract traces to apex; patient is asymptomatic.

During irrigation, the clinician wants to avoid NaOCl–CHX precipitate.

A 36-year-old has painful chewing and a narrow isolated deep periodontal probing on the distal root of a treated molar.

A 40-year-old reports severe pain after access but canals were not entered; occlusion normal; no swelling.

A 27-year-old with symptomatic irreversible pulpitis asks for the best pain control.

A 32-year-old has an open apex non-vital incisor after trauma; canal is wide and short.

A 55-year-old with symptomatic retreatment needs outcome improvement.

A 47-year-old complains of biting pain; transillumination shows crack from marginal ridge; probing normal; cold normal.

After obturation, the working length radiograph shows short fill 2 mm from apex; canal was dry and patent at length.

A 56-year-old presents with lingering pain to cold and spontaneous night pain from a maxillary first molar; radiograph shows deep distal caries close to the pulp.

A 40-year-old with necrotic lower molar and symptomatic apical periodontitis cannot achieve profound anesthesia after IAN block.

A 33-year-old has previously treated maxillary lateral incisor with persistent apical radiolucency; post is present and canal is underfilled.

During access on a mandibular molar, a sudden blood-stained “drop” is felt on the distal wall; paper points show profuse bleeding.

A 27-year-old with symptomatic irreversible pulpitis asks for best analgesic strategy pre-op.

A 60-year-old on warfarin (INR 2.6) requires emergency pulpectomy for acute pain.

A 24-year-old presents with wide open apex non-vital central incisor after trauma; canal is necrotic and discharging.

A 38-year-old with previously treated molar has persistent symptoms; CBCT shows missed MB2 canal.

A 42-year-old reports severe pain and swelling 48 hours after starting RCT; fluctuant swelling is present.

During canal negotiation of a curved mesiobuccal canal, a ledge is created and working length cannot be reached.

A 49-year-old has lingering cold pain but normal percussion; deep proximal caries approximates the pulp.

After obturation, a puff of sealer extends beyond apex; patient is asymptomatic.

A patient with necrotic tooth and acute apical abscess receives I&D and canal drainage; asks if antibiotics are necessary.

A 36-year-old molar has calcified chamber; canals not visible after standard access.

A 31-year-old has persistent exudate preventing dry canal at length in a necrotic tooth.

During irrigation, clinician plans to remove smear layer.

A 45-year-old presents with narrow, isolated deep pocket on distal root of a treated molar; J-shaped radiolucency.

A file separates in apical third of a necrotic canal before reaching working length; patient is asymptomatic.

A 50-year-old with symptomatic previously treated tooth has a large post, minimal ferrule, and persistent lesion.

A traumatic intrusion of a permanent incisor (6 mm) in a 16-year-old with closed apex.

A 29-year-old reports severe cold pain that lingers and wakes him at night; percussion negative.

A 35-year-old complains of severe pain after obturation; occlusion is high; no swelling.

A 43-year-old molar shows internal resorptive defect with pink spot clinically; pulp tests vital but inflamed.

A patient on bisphosphonates needs RCT on a molar with symptomatic apical periodontitis.

After instrumentation, working length radiograph shows over-enlargement and zipping of apex.

A 21-year-old avulsed a permanent incisor 2 hours ago kept dry; closed apex.

A 48-year-old with symptomatic apical periodontitis and limited mouth opening cannot tolerate long appointment.

A 32-year-old presents with invasive cervical resorption (Heithersay class 2); tooth is asymptomatic.

A mandibular molar with S-shaped canal requires shaping.

After obturation, a maxillary molar has short fill in one canal and proper fill in others; patient asymptomatic.

A 37-year-old has symptomatic molar with deep pocket and generalized periodontitis; tooth is vital with lingering cold.

During irrigation with NaOCl, patient reports burning sensation at lip; rubber dam clamp is loose.

A 55-year-old with retreatment needs a post afterward. Optimal apical gutta-percha length to retain?

A 28-year-old with symptomatic irreversible pulpitis in mandibular molar has limited time; considers pulpotomy.

A 46-year-old with necrotic tooth and fluctuant swelling is allergic to penicillin (immediate type).

A previously treated incisor with persistent apical lesion has well-condensed obturation to length and a cast post; patient refuses post removal.

A 30-year-old reports severe pain on biting; transillumination shows crack across marginal ridge; cold test normal, percussion tender.

A 58-year-old with poorly controlled diabetes presents with necrotic tooth and facial cellulitis.

A 41-year-old patient has persistent sinus tract after RCT; tracing leads to furcation; CBCT suggests strip perforation in MB canal.

A 52-year-old complains of bad taste and swelling two weeks after obturation; radiograph shows missed lateral canal on distal root.

A 26-year-old at 22 weeks’ pregnancy has severe lingering cold pain in a lower molar; no swelling or fever.

A mandibular second molar shows a continuous C-shaped canal on CBCT; patient has dull chewing pain.

A maxillary lateral incisor with dens invaginatus (Type II) is necrotic with apical lesion.

A 13-year-old fractured a premolar with dens evaginatus; pinpoint pulp exposure, tooth otherwise asymptomatic.

A 35-year-old presents with a yellow, asymptomatic maxillary incisor after trauma years ago; normal periapex; cold test reduced.

During instrumentation of a vital molar with hyperemic pulp, persistent bleeding prevents dry field.

A replanted avulsed incisor (closed apex) shows radiographic external inflammatory resorption 3 weeks post-injury.

A 9-year-old’s replanted incisor demonstrates replacement resorption/ankylosis and progressive infraocclusion.

A mandibular incisor with RCT has persistent lesion; tracing shows sinus tract to lingual aspect; radiograph suggests missed lingual canal.

A maxillary molar shows taurodontism on radiograph; endodontic access planned.

A patient develops facial swelling and fever 24 hours after obturation of a necrotic molar; percussion severe; fluctuant swelling present.

A cervical “pink spot” lesion is diagnosed as invasive cervical resorption (Heithersay class 3); pulp still tests vital.

A 28-year-old reports lower lip paresthesia after RCT of a mandibular molar; radiograph shows sealer extrusion into mandibular canal.

A molar with generalized periodontitis has deep pockets; the tooth is non-vital with apical radiolucency.

Retreatment is planned through a PFM crown; crown margins are sound.

A large apical radiolucency remains after initial shaping of a necrotic molar; canals still exudative.

Working length is difficult to determine due to a large apical lesion; apex locator readings fluctuate.

A mandibular molar with symptomatic irreversible pulpitis under IAN block is still painful on access.

A chronic unilateral maxillary sinusitis is traced to a necrotic maxillary molar with periapical pathology into the sinus.

Patient refuses rubber dam for RCT due to “gagging.”

After obturation, painful swelling occurs; drainage through the canal is not possible due to set sealer.

A mandibular premolar shows sudden “ledge” formation; WL cannot be reached.

A retreatment case has gutta-percha and sealer resistant to files.

A fiber post is deeply cemented; core is loose; retreatment indicated.

Patient cannot return for 4 weeks after access; a durable temporary is needed.

The patient develops perioral burning and urticaria minutes after NaOCl contact; breathing stable.

A calcified anterior tooth becomes symptomatic (lingering cold); canals cannot be found with standard access.

A mandibular second premolar shows sudden file deviation; radiograph reveals two separate canals (Type IV).

A retreatment molar with silver cones shows persistent apical lesion.

A previously well-filled incisor has persistent lesion; biopsy confirms true cyst.

A necrotic molar patient asks if single-visit RCT is okay; no swelling or exudate.

After obturation, WL film shows overextended master cone 1 mm beyond apex in one canal; patient asymptomatic.

A diabetic patient with cellulitis from a necrotic molar is febrile and toxic.

A deep split in a mandibular molar shows isolated deep probing on distal root; tooth had recent RCT.

A large open apex incisor is necrotic; clinician considers CHX as main irrigant.

A previously treated molar has persistent sinus tract; WL and fill are adequate; CBCT shows apical scar.

To reduce flare-ups in necrotic teeth with large lesions, which inter-appointment step is most helpful?

A mandibular molar with severe curvature shows apical transportation (“zip”) after aggressive filing.

A deep caries case with reversible pulpitis prefers “no drilling” if possible.

A mandibular molar has a sinus tract draining through a deep periodontal pocket; pulp tests non-vital.

A mandibular molar with a full metal crown shows wildly fluctuating apex locator readings; the file occasionally touches the clamp/crown through saliva.

After shaping a curved canal to size 30, the master cone is loose with no tug-back.

Despite side-vented needle irrigation, the mesial roots of a mandibular molar remain debris-laden; irrigant does not seem to reach the apical third (vapor lock).

A brown precipitate forms after switching from NaOCl to CHX without an intermediate rinse.

A necrotic molar with a large periapical radiolucency remains exudative at length; drainage achieved.

Anterior tooth with invasive cervical resorption (Heithersay class 4) extending below the bone crest; tooth is non-restorable.

A cracked mandibular molar received RCT today; cusps are thin and undermined. The patient asks about timing of the final restoration.

A patient has persistent biting pain weeks after technically adequate RCT; cold is negative; transillumination shows a crack crossing the marginal ridge.

Apicoectomy is planned for a tooth with persistent apical pathology after adequate orthograde retreatment is not feasible.

A necrotic incisor with a blunderbuss apex requires irrigation; the clinician worries about NaOCl extrusion.