Irreversible pulpitis on mandibular first molar. Long,calcified and S shape root canal system made this procedure a rather challenging one. Endodontic procedure instrumentation has been performed with Mani stainless K files and ProTaper Universal (Dentsply). Chelator: RC Prep. PUI Irrigation: NaOCl 5%. pulp stones removal with Ultrasonic tip: BUC One from Spartan. P5 (Dentsply) Sealer used: Pulp Canal Sealer. Obturation technique WVC. X Ray Sensors used: CareStream Kodak 6100. Opmi Proergo microscope. Tooth is ready for crowning.
Root canal system in apical third of this second mandibular molar is barely visible on pre operative dental X ray image indicating an almost complete root canal stenosis. When performing root canal shaping and cleaning in such an abrupt canal narrowing with an S form, Niti files will readily break without warning (This happened in mesial root of the molar next to this one. A glidepath has been shaped with stainless K files (06 to 15) prior to NiTi shaping. Pulp chamber is also very narrow and endodontic microscope has been most helpful in this case to uncover the pulp chamber without perforating the chamber floor. A Nayyar amalgam core build up performed during the same setting.
Endodontic procedure instrumentation has been performed with Mani stainless K files and ProTaper Universal (Dentsply). Chelator: RC Prep. PUI Irrigation: NaOCl 5%. pulp stones removal with Ultrasonic tip: BUC One from Spartan. P5 (Dentsply) Sealer used: Pulp Canal Sealer. Obturation technique WVC. X Ray Sensors used: CareStream Kodak 6100
This case has been posted on a specialized root canal FB forum and earned 596 likes from dentists around the world. See this case at: International Root Canal Procedure Forum
A single canal fast break usually indicate a split in root canal apical third. In this mandibular first molar the canal had split into three branches. Each of it having its own portal of exit. Each branch had to be successively shaped then filled. High magnification with coaxial Xenon illumination allowed to visualize those entries during the procedure. Instrumentation has been performed with Mani stainless K files and ProTaper Universal (Dentsply). Chelator: RC Prep. PUI Irrigation: NaOCl 5%. Ultrasonic tip: BUC One from Spartan. P5 (Dentsply) Sealer used: Pulp Canal Sealer. Obturation technique WVC. X Ray Sensors used: CareStream Kodak 6100.
42 year old patient had pain to both cold and hot and could not eat on this side for the late 7 months. She has been seen by two previous dentists and endured a lot of pain for so long because pre operative X rays showed no signs of visible recurrent tooth decay as well as no obvious signs of periodontal ligament thickening, both X ray signs indicating a potential need for a root canal. Composite filling also showed no clinical signs of leakage. Upon reading the pre operative Xray we could see that the pulp horns were very long and almost touched the filling. I suggested to remove composite filling in order to check underneath. Tooth decay was indeed present and pulp got exposed before the completion of tooth decay removal. Furthermore a vertical crack line was present in distal. Patient also fractured and lost her second mandibular molar due to clenching.
A 70 year old patient complained about mastication difficulty due to the
loss of mandibular first and second molars for many years. He wanted a fixed
prosthesis to replace his removable one but did not want implant surgery
because his thin alveolar ridge would also imply a block bone grafting.
Patient knew that he could not overcome his dental surgery fear.
Throughout his life, he never wanted to pull out his badly worn wisdom tooth
and always insisted to have it filled over and over again. It turned out in
the end, that he was right because a root canal treatment allowed for this
tooth to be preserved and used as a fixed dental bridge abutment sparing him
the need for a wisdom tooth extraction and also two more implant related
His tooth position in the arch, tooth axis inclination, calcified canals
made this root canal treatment a difficult one to perform
An intricate endodontic therapy to perform in order to preserve a very painful tooth, patient was taking 3 X 200mg Ibuprofen Pills every 3 hours in order to get through the preceding night. Serous exudate accumulation resulted in mucosa swelling
This type of root canal treatment has a high level of difficulty because debridement of those ribbonlike C shape root canals is extremely painstaking to perform.
These pictures of a “C” shaped second mandibular molar from the rootcanalanatomyprojectblogspot.com have been taken by Dr Marco Versiani. They display the complex anatomy of such a root canal system. Those pictures give a better understanding on how difficult the cleaning and filling tasks of a “C” shape root canal may be.
Calcified root canals entries where located with the help of a Carl Zeiss Microscope. These where embedded in a mass of pulpstones and calcifications which had to be removed with an ultrasonic tip. Calcium Hydroxide Antibacterial gel insertion was mandatory to control infection within the root canal system. This gel has been removed in a subsequent appointment and replaced by a permanent root canal filling. Tooth corono apical build up is an amalgam Nayyar core. A permanent crown is planned.
Endodontic. Case Study Number 525214
Locating both root canal entries without lateraly perforating the root and without destroying to much sound tooth structure in order to keep tooth restorable, then, cleaning and shaping those root canals without loosing patency, without breaking an endodontic file and without perforating the root represent the two major endodontic procedure problems to overcome when treating calcified canals with an S form.
ROOT CANAL PROCEDURE CASE STUDY NUMBER: 542917
Tooth number 16 has to be removed, tooth number 17 becomes a key tooth as an abutment for a fixed 17X15 bridge. POST ENDODONTIC PROCEDURE OUTCOME AMALGAM POST AND CORE BUILD UP