Microendodontics. Case Study Number 503746
A 40 years old male patient presented for an emergency dental examination.
Chief complaint: pain and swelling, unable to chew on right side
Clinical examination: gum swelling, broken filling, tooth tender to palpation and (gentle) pressure, tooth did not respond to thermal or electric sensitivity test, periodontal probing depth are wnl.
Radiographic examination: huge calcifications in distal root canal and pulp chamber, periapical radiolucencies around both roots, mesial pulp horn are in direct contact with saliva
The diagnosis was acute periapical periodontitis associated with an infected necrotic pulp.
The patient was keen to retain his tooth, therefore, went ahead with root canal treatment
First appointment: gaining access to root canal system (calcifications removal), shaping and cleaning, 5% NaCl, paper points and Ca(OH)2, coton pellet and provisional filling (Cavit)
Second appointment: Ca(OH)2 removal, rinse, dry, final obturation Pulp Canal Sealer and gutta percha, Nayyar core build up
A very rare anatomical variation: A Vertucci’s type V configuration in distal root and mesio vestibular portal of exit oriented toward mesial. Engine driven files beware!