calcified canal | ENDOMONTREAL

Preserving a natural tooth or an implant therapy?

November 29, 2015 By Dr Pierre Pizem 2 Comments

On the pre operative X Ray, this asymptomatic tooth looks badly worn and its root canal is calcified, still, this tooth periodontal status is good and its crown to root ratio would still be acceptable even after having performed a potential crown lengthening procedure. Casted post bevelled margin preparation will include 2mm of preparation length on solid tooth to ensure an adequate length of parallel wall to achieve an effective ferrule.

In this case overall outcome success mostly relied on an intricate root canal procedure outcome. Dental operating microscope has been most helpful when attempting to locate this narrow root canal entry and thus, played a key role in helping preserving this natural tooth. Being able to perform a root canal in this case allowed the patient to preserve its tooth instead of extracting it and replacing it with a dental implant.

Root canal 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.

Saving a Tooth Through an Intricate Root Canal Procedure

August 27, 2015 By Dr Pierre Pizem Leave a Comment

The patient urged my referring dentist to save his own natural tooth even though it was badly decayed and it presented with an uncomplicated crown fracture on its lingual side. Despite its apparent questionable restorability on pre operative Xray, the tooth is very long and its periodontal status is good so we accepted to perform both the root canal procedure and the post and core build up.

RCT procedure on this maxillary molar has been a time consuming one mostly due to its calcified root canal system and its 26mm length. MB2 root canal entry has been located with the help a dental operating microscope high magnification along with a coaxial Xenon illumination.
Armamentarium: Zeiss’s OPMI PROergo Dental Operative Microscope , 556 straight cross cut carbide tungsten bur, Ultrasonic tips (BUC 3), RC Prep, many Mani K files (envelop of motion), ProTaper Universal, 6% NaOCl, PUI, Pulp Canal Sealer + W.V.C.

Tooth has been restored with a FlexiPost (cemented with RelyX luting cement) and an amalgam core build up. (Slight excess of amalgam seen on post operative X ray on palatal aspect of the tooth has been removed prior to sending patient back to his own dentist for crowning)

A Difficult Root Canal Treatment on Calcified Root Canals

April 23, 2014 By Dr Pierre Pizem 1 Comment

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 calcified canal shaping is prone to endodontic file torsional fracture inside the tooth. 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 ultrasonic tips. Shaping performed with stainless steel K hand files 06, 08, 10, 15, 20,25, 30 from Maillefer (Envelope of motion technique and lots of chelating agent). 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. (Cold lateral condensation gutta + Pup Canal Sealer)

Root Canal Treatment on a Tooth Presenting With a Rare Anatomical Variation

December 9, 2013 By Dr Pierre Pizem Leave a Comment

Mandibular first premolar, necrotic pulp, AAA, patient has a gag reflex making it difficult to take a pre op. X ray dental film revealing a peculiar anatomy variation.

First appointment procedure: Access opening, copious NaOCl 2,5% irrigation, two canal entries located by pre bending and scouting through deep main canal constriction, followed by 06,08,10,15 K files from Many. Irrigation protocol: NaOCl 2,5%, absorbent paper points + EDTA 17%, absorbent paper points, CHX 2% for 1-2mn, absorbent paper points, intracanal medication: Ca(OH)2 loaded with Barium Sulfate + Iodine (Metapaste), Teflon, Cavit. Barium sulfate displays a third canal in post operative dental X Ray film.

Patient is seen 3 weeks later, no more symptoms, scouting with pre bent 08 K file could not be of any use in locating this third canal entry neither as high magnification with coaxial Xenon light. Two previously located canals are shaped up to a 20 K file, followed by ProTaper “original” NiTi file sequence up to F3 in order to allow for ultrasonication. Adding ultrasonication to same irrigation+drying protocol, Pulp Canal Sealer and cold lateral followed by warm vertical in order to maximize the odds of “sealing” what will remain, despite all my efforts, an accessory canal.

Intricate S Shape Root Canal Procedure on a Calcified Second Mandibular Molar

November 15, 2013 By Dr Pierre Pizem Leave a Comment

A Root Canal Treatment on a Badly Worn Wisdom Tooth, Was it Wise?

November 7, 2013 By Dr Pierre Pizem Leave a Comment

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
surgeries.

His tooth position in the arch, tooth axis inclination, calcified canals
made this root canal treatment a difficult one to perform
in 2008.

Relieving Pain With An Intricate Root Canal Treatment on a C Shape Root Canal

November 1, 2013 By Dr Pierre Pizem Leave a Comment

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.

Root Canal Procedure on Calcified Wisdom Tooth Presenting With a Severe Root Canal Curvature

October 25, 2013 By Dr Pierre Pizem Leave a Comment

Advanced Root Canal Procedure on a Tooth Presenting with a severe Root Canal Curvature

: Root canal procedure on Calcified and Curved Root Canal

Root Canal Therapy on a Calcified Root Canal With an S Form Curvature (Case 525214)

October 18, 2013 By Dr Pierre Pizem Leave a Comment

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.

This Patient Chose Orthograde Endodontic Revision Procedure on his Mandibular Premolar Instead of Extraction and a Dental Implant

June 7, 2013 By Dr Pierre Pizem Leave a Comment

Because of the huge post cemented within its root canal, the endodontic revision procedure to save her tooth seemed to be too difficult or too risky for the former practitioner to perform, consequently, patient has been offered a surgery to extract this infected and painful mandibular premolar and to replace it by a dental implant.

But patient would rather save her own tooth and asked for a second opinion. Patient has been explained that all it would take to preserve that tooth is to clean and disinfect contaminated canal area. In order to reach this contaminated area, a huge casted post must be removed from root canal, Sargenti paste must also be retrieved and a ledge has to be bypassed. Risks associated with this procedure where also explained. Patient choose to accept those risks.

It took twenty minutes in order to retrieve the casted post. Sargenti paste has been brushed away with ultrasonic tips from Spartan under high magnification (OPMI PROergo microscope from Carl Zeiss) and ledge was bypassed within 10 minutes working time. A number 10 file displays full canal patency on this X Ray dental film.

Calcium Hydroxide has ben used as an intra canal medicament and left in for 8 days

Tooth became asymptomatic on following appointment.
Final obturation (Pulp Canal Sealer + Gutta Percha).
Provisional obturation material: Clip from Voco.
Tooth has been saved no implant needed.