Case No. 20: RA for endo. in a 14 yr old

Today I undertook an endo treatment for a 14 yr old in an upper 2nd pre-molar. She has been a patient since she was about 5. She is a very pleasant young lady who is just a tad over-protected and is at the awkward teenage stage.During her fixed ortho. (Carried out on referral to an orthodontist) she dropped out of regular attendance and re-appeared with pulpitis from a deeply carious cavity a few weeks ago.

I used RA then to undertake a vital pulpotomy without problems. On titration, she took a little longer to become adequately sedated and a slightly higher % of N2O than I would have guessed. However this first session gave us a datum level to work at for the next session. She returned today for the Endo at UR5.

We quickly established sedation at the previous O2/N2O level. During induction, topical was applied and once sedated, the LA was given with no response from her. We waited a few minutes, applied a rubber Dam and the endo was completed without any reaction from her at any time. This included application of rubber dam clamp, Hawe- Neos clear Matrix and a wedge to complete a composite filling with a glass ionomer base.

The composite was placed with a compression instrument to achieve a good contact. On removal of the rubber dam clamp I noted it had compressed the unanaesthetised palatal gingival margin somewhat. Again this had elicited no response from her and will recover quickly I am sure. 2 intra-oral peri-apical films were taken with digital sensors and holders, which are generally quite uncomfortable for many, again without reaction from her.

RA can achieve this for you and your patients too!