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!
Case Study Number 455336
Irreversible pulpitis, deep carie, deciduous restoration, broken lingual wall. First molar with 4 root canals. Two mesial root canals no longer visible in middle and apical third with a curvature into “C” form. A file number 08 ISO follows a 90 degrees curvature in one of two distal root canals (per op. X ray dental film).
These canals in the distal root are presenting a dilaceration or sudden angular bend, according to Dr John Ide Ingle:
“The major problem in these cases is the exploration, hence the pathfinder curve in the instrument”.
To my opinion, the main problem is the complete files sequence. These curves require much more endodontic expertise to deal with than the mesial root gradual curve.
Pulpitis irreversible, caries profunda,restauracion obsoleta(caduca, en pesimas condiciones), pared lingual fracturada(quebrada). Primer molar con 4 canales radiculares. Dos canales radiculares mesiales no visibles de lejos en tercio medio y un tercer canal radicular con una curvatura interna en forma de “C”. Una lima 08 ISO seguida con una curvatura de 90 grados en uno de los dos canales radiculares distales.