ENDOMONTREAL

Dr Pizem Advanced Endodontics Procedures

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An Extreme Root Canal Treatment Procedure

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Patient seen on an emergency basis for irreversible pulpitis on second maxillary molar. Pulp stones removal and pulpectomy performed + interim Ca(OH)2 on palatal canal only.
I had to make the patient come back for another setting to complete RCT.
The most difficult part of this procedure has been to obtain patency in a remote mesio vestibular canal as it was located at the bottom of a pulp chamber presenting with taurodontia and also because this canal had a very sharp curve in the first mm of its coronal part. Microscope Opmi ProErgo, Mani K stainless endodontic files, ProTaper from Dentsply.

 

Root canal treatment procedure on 27 taurodontia and calcified A 2016-06-07  Root canal treatment procedure on 27 taurodontia and calcified B 2016-06-07  Root canal treatment procedure on 27 taurodontia and calcified B 2016-06-07

Carl Zeiss Opmi Proergo Microscope VS Complete Stenosis of an Apical Root Canal Split

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Atypical Canal Configuration, Type V, Root Canal Treatment Pre Therapy 48744-1

Atypical Canal Configuration, Type V, Root Canal Treatment Pre Therapy 48744-1

Atypical Canal Configuration, Type V, Root Canal Treatment Per Therapy 48744-1

Atypical Canal Configuration, Type V, Root Canal Treatment Per Therapy 48744-1

Atypical Canal Configuration, Type V, Root Canal Treatment Per Therapy 48744-2

Atypical Canal Configuration, Type V, Root Canal Treatment Per Therapy 48744-2

Atypical Canal Configuration, Type V, Root Canal Treatment Post Therapy 48744-1

Atypical Canal Configuration, Type V, Root Canal Treatment Post Therapy 48744-1

Atypical Canal Configuration, Type V, Root Canal Treatment Post Therapy 48744-2

Atypical Canal Configuration, Type V, Root Canal Treatment Post Therapy 48744-2

Calcified Canals. Case Study Number 487445

Clinical examination: Sinus tract, mobility: 0, deciduous amalgam restoration.

Radiographic examination: Alveolar bone with circumscribed lucency, apical root canal split, hypertaurodontism (bull’s tooth), apical root canal split branches not visible on X ray dental film, hypercementosis

Diagnosis: pulpal necrosis with chronic periapical infection,

Etiology: marginal leakage, caries

Root canal procedure:

First appointment: gaining access to the split, locating entries, shaping and cleaning apical root canal branches inserting intracanal medication for 8 days.

Second appointment: intracanal medication retrieval, copious CHX 2% irrigation, drying canals and permanent root canal obturation with Pulp Canal Sealer and gutta percha (lateral and vertical condensation).

In that specific case, microscope was most helpful during all the following steps necessary to insure a better prognosis for this patient:

1) Locating and gaining access to buccal and lingual root canal entries (apical split was clearly visible under magnified observation)

2) Striving to find a third branch in apical split minimizing the chances of omitting an untreated canal

3) Aiming at the right root canal orifice when:

  • Inserting the two first endodontic files to confirm canal lengths
  • inserting a file sequence to shape and clean each canal
  • Positioning irrigating syringe needle tip and calcium hydroxide syringe tip toward the right canal entry
  • Inserting absorbent paper points in both canals when drying canals
  • Inserting master, accessory gutta percha cones and finger plugger when doing final obturation with lateral and vertical condensation

4) Checking for pulpal tissue remnants prior to final obturation to minimise the chances of pushing them back into the apical area