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22 I I case report _ endodontic zone _She was related to my practice neighbour, a good friend and a very talented oral surgeon (OS), and was visiting him in Santa Barbara for the holidays. She was experiencing intractable pain in her left facial region. Could I see her today? Two weeks before, her general dentist had referredhertoanendodontist,whotreatedtheroot canal in tooth #19. However, the pain continued to escalate thereafter and endodontic treatment of tooth#20washissecondarytreatmentplan.Fortu- nately, she left before that tooth was invaded. WhenImetheratmyfrontdesk,Iquestionedher aboutherchiefcomplaint—thechronology,eliciting factors and the pain referral pattern of her symp- toms.Shestatedthatthepainhadbeenintensifying for the last two weeks, was spontaneous in onset and,forthemostpart,shewasnotawareofthermal sensitivity. The patient felt pain in her upper and lower left teethanddownherneck.Iimmediatelythoughtthat this might be a classic case of myofascial pain mas- querading as an endodontic problem. While dying pulp will refer pain indiscriminately to both upper and lower jaws, it never refers pain below the lower borderofthemandibleorabovethepatient’scheek- bone. I call it the endodontic zone (EZ). When asked whether she had any history of myofascial or joint pain, the patient informed me that her temporo- mandibularjointclickedandthatshehadanocclusal night guard, which she had not been wearing lately. So,notreactivetothermalstimulus,painreferred outside the EZ and a history of temporomandibular dysfunction—interesting. I thought that I had diag- nosed this case in my reception area and that I had the wonderful opportunity to tell the patient that she did not need another root-canal treatment. My assistant took the patient back to an opera- tory, took conventional X-ray (Figs. 1 & 2) and CBCT images, and gathered clinical findings and pulp testing data. No peri-radicular pathosis was seen in any of the X-rays, cold tests of all teeth on the left side of the patient’s face were within normal limits (WNL), and I was itching to find the myofascial trig- ger-pointthathadbeenmakinghermiserable.Ihad her open half-way—as per Dr Janet Travel—then palpated her left masseter and temporalis muscles but they were stellar—surprising! Fig. 1_Pre-op radiograph showing a well-performed root-canal therapy on tooth #19 (conservative access preparation and coronal shapes, dense fills to each canal terminus). Tooth #20 was treatment planned for root-canal therapy after the patient’s pain had not been alleviated by treatment of #19. Fig. 2_Pre-op radiograph of the maxillary arch, showing relatively large pulp horns in the chambers of teeth #13, 14 and 15, with restorations near each of them. roots2_2011 Acase of diagnosis by access Author_ Dr L. Stephen Buchanan, USA Fig. 1 Fig. 2