Inside a Rare “Pulp in Flux” Case

I’ve learned that the diagnosis I make before treatment doesn’t always match what I find once I’m inside the tooth.

In this clinical tip, I share a challenging case where all the preoperative evidence, including radiographs, CBCT imaging, and pressure testing, pointed to necrotic pulp in tooth #14. But when I gained access, the pulp told a very different story.

One canal was fully vital, another completely necrotic, and the rest somewhere in between, a rare condition I refer to as ‘pulp in flux.’ I’ll walk you through my step-by-step decision-making, how I adapted when the findings didn’t match the tests, and why sometimes the only way to know for sure is to look inside. This case is a great example of how I interpret diagnostic data, manage partial necrosis, and adjust my approach when the pulp has other plans.