A new Dental Operative Microscope (D.O.M.) Assisted Root Canal Treatment in a Calcified Maxillary Lateral Incisor.
Case Study Number 501812
Radiographic findings: Dystrophic calcifications in the whole canal system are completely obliterating the pulp chamber as well as the root canal itself. It ca be expected that the root canal entry is completely embedded in a mass of adherent pulp stones.
Endodontic procedure problem number one to solve: Locating root canal entry without lateraly perforating the root and without destroying to much sound tooth structure in order to keep tooth restorable.
Endodontic procedure problem number two to solve: Cleaning and shaping located root canal without loosing patency, without breaking an endodontic file and without perforating the root.
This is an extreme endodontic procedure. A few years back, when there was no surgical operating microscope in our dental practices and only a handfull of daring (and caring) pioneers in microendodontics trained by Dr Garry B. Carr (who is an endodontist acknowledged to me as the “father of microendodontics”), removing this tooth and replacing it by an implant supported crown would have been a good option to consider in most instances.
Times have changed. In order to save that tooth, calcified dentin must be carefully removed with long thin ultrasonic tips under the high magnification of dental operating microscope (OPMI PROergo from Carl Zeiss). No rapid technique exists for dealing with calcified root canal system. In this specific case ultrasonic tip went off centered creating a groove in canal toward distal, X ray dental film taken during the root canal procedure alowed us to notice this and alowed us to correct the tip orientation before making a perforation. This groove has been filled within the canal itself with Geristore from DenMat. Root canals has been shaped and cleaned with Protaper endodontic files and 06, 08,10 K in combination with chelating agent (RC PREP). Canal system has then been filled with Pulp Canal Sealer and Gutta percha laterally and vertically condensed. Provisional filling material: ProTemp (A provisional crown with anchorage).
Last X Ray dental film is a post operative control, the referring dentist asked us to make and cement a casted post in order for him to cement a planned fixed crown.