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Endodontics · single question

During root canal treatment of an asymptomatic tooth with an existing apical radiolucency, the patient suddenly experiences sharp pain during instrumentation. What is a plausible explanation, beyond simple anesthesia wearing off?

  1. A file separated/broke and was pushed beyond the apex into periapical tissue
  2. The tooth has no nerve supply at all
  3. The patient is exaggerating the sensation
  4. This is an entirely expected, harmless occurrence requiring no further attention
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Correct answer: A. A file separated/broke and was pushed beyond the apex into periapical tissue

If an instrument separates (breaks) during canal preparation and is inadvertently extruded beyond the apex into periapical tissue, this mechanical trauma to periapical structures can cause sudden, sharp pain even under otherwise adequate pulpal anesthesia, since periapical tissue may not be as densely anesthetized as the pulp itself.

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