Due to the presence of rock hard Russian Red filling material in 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 maxillary premolar and to replace it by a dental implant.
Still, patient would rather save her own tooth and asked for a second opinion. Patient has been explained that this tooth periodontal prognosis is excellent, it is restorable and that its endodontic prognosis is solely linked to the difficulty of the case at hand. All it would take to preserve her tooth would be to clean and disinfect contaminated canal area. In order to reach this contaminated area, Russian Red paste had to be retrieved then, the calcified apical third of root canal system had to be cleaned and shaped. Root canal perforation and blockage risks associated with this procedure where also explained. Patient choose to accept those risks.
Russian Red paste has been brushed away with ultrasonic tips from Spartan under high magnification (OPMI PROergo operative microscope from Carl Zeiss) and both calcified canals were shaped and cleaned to length (25 mm long tooth) with C endodontic files, K files, Protaper Universal system and lots of chelating agent (RC Prep). Irrigation PUI with sodium hypochlorite 5%. Interim Calcium hydroxide was left in root canals for 10 days, then these were subsequently filled with both Pulp Canal Sealer and single cone technique.
It is sad to note that this first maxillary premolar narrowly escaped from extraction and dental implant therapy only because patient insisted on asking for a second opinion.