hai friends .... I got case of food impaction along with hypersensitivity irt 45 46 three months ago I done root canal treatment... n after one month he came with tenderness regarding that teeth.. I took iopa and repeated root canal treatment again and placed gp points short of Apex due to his feeling of pain up to Apex... then after he again facing same complaint of tenderness with the same teeth these r the iopa regarding that.. and he also have trigeminal neuralgia on left side...Soo he is taking tegretal400mg daily please suggest advise he is also close friend of my dad

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Placing GP short of Apex is no solution at all. If anatomical apex is gauged correctly it's just excellent. Use apex locator if confusing. Trigeminal neuropathy or neuralgia on left side has nothing to do with 45 46. Mostly some missed accessory canals or referred pain due to -Rt TMJ if any -Spondylosis C2 C3 -Also rule out Ear ...ENT. -Rule out Any high points

Thank you sir.. But no high points detected
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All probabilities already meticulously discussed. What's the health of the upper right posteriors? Sir, even if we suspect bilateral trigeminal neuralgia (extremely rare)... but the patient already on Carbamazepine. How is the general health of the patient?

General health of patient is fine .... And upper also attrited but there is no complaint of sensitivity
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45 is short and one of mesial root in 46 is also short of gp.....dead space is an invitation to the problems ..... remove crowns and check which teeth is top +ve ??Make separate crowns ....44 also needs crown ......check high points and periodontal pockets ...there is a bit of bone loss .....that can also result in to food impaction and pain ......do localised curettage..... prescribe metronidazole 400mg 1 TDs for 3 days ......

There is lost of thing can happen..High points Irrigation was not proper..Agitation bmp was not proper..Perforation..Etc. advice pat for CBCT...Remove gp and place calcium hydroxide for 2weeks..Recall

Sir I did rct twice...and I did good irrigation n I intentionally placed gp point under Apex...due to his pain feeling...and I did my filling up to Apex in first time done treatment
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Along with fair amount of root resorption distal to 46 it's probably periodontal component crying foul. Secondly & importantly get a CBCT done as u may have missed a canal bcoz u hvnt mentioned anything wat u got in 45/46 no of canals ? Lastly TN affected left side won't have any effect on lower right quadrant as it doesn't cross the midline unless bilateral pathology .Severe bone loss evident along distal periodontal pocket to 46 although Iopa's are not that clear. Do the exploration & post feedback of CBCT results. Do attach clearer intraoral pic if any.

I got 45 single canal n 46 three canals I will take intra oral pic after 5 days when he come to us
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Check high points. Check for any crak / fracture... Check adjacent tooth..

1. Patient is having trigeminal neuralgia on left so he is using right side more for mastication. 2. The patient must be checking for tenderness at home with some objects like a heavy pen or keys etc. So tell the patient to use his left side and advice him not to check tenderness by himself. Hope it will help

I already tried and told him sir but no response
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Is there any deep pocket present between 46 47???

No sir
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Trigeminal neuropathy Carbamazepine Cbct

I think 46 may have 4 canal

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