Dental operating microscope assisted root canal procedure on a completely stenosed canal system (calcified canal).
Endodontist. Case Study Number 506712
In order to be preserved and used as an abutment for a fixed bridge replacement, this tooth must have a casted post space preparation in its coronal third. Thus apical endodontic surgery cannot be considered as the best option for the patient.
Pre operative condition:
- Canal is not visible on dental X ray film until last few millimeters because the root canal anatomy system does not begin before last few millimeters, this means an extremely narrow canal diameter for the practioner to locate in last apical third of root. Remaining canal diameter can be 3 times smaller than a single strand of human hair diameter. Remaining within tooth long axis when accessing canal entry is of the utmost importance not to create a iatrogenic perforation.
- Two previous failed attempts to locate tooth single canal entry, this means complete loss of landmarks when looking through dental operative microscope lens to find it
- Number 12 tooth is a 12X21 bridge abutment, this means loss of external landmarks to locate canal entry
- Dentine shade composite completely fills up the access cavity, this means even more challenge, when drilling to expose canal entry, not to create additional tooth substance loss (thus increasing tooth weakness.
Tooth survival relies solely on endodontic procedure success, if canal cannot be found thus treated, tooth cannot be preserved.
While being a less straightforward approach than implant therapy, this successful endodontic procedure outcome strongly suggests that, nowadays, a complex root canal retreatment does not necessarily have to mean extraction and replacement by a dental implant.
Surgical operating microscopes have a steep learning curve and require training, as well as patience and practice to master. Still this piece of equipment and the learning effort it implies is well worth it since cases that once seemed impossible can now be treated with a high degree of confidence and clinical success.