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You are here: Home / Archives for Embedded pulpstones

Removing a Tiny Fractured Instrument Fragment from a Root Canal System.

September 13, 2013 By Dr Pierre Pizem Leave a Comment

Dental Operative Microscope and Retreatment, Dealing with Broken Instruments Removal, Root Canal Treatment Pre-Therapy Dental Operative Microscope and Retreatment, Dealing with Broken Instruments Removal, Root Canal Treatment Pre-Therapy (2)Dental Operative Microscope and Retreatment, Dealing with Broken Instruments Removal, Root Canal Treatment Per-Therapy Dental Operative Microscope and Retreatment, Dealing with Broken Instruments Removal, Root Canal Treatment Post-Therapy

  1. Mass of embedded pulp stones is still present in pulp chamber and it must be removed to increase both retention and strength of planned core
  2. Big chunk of metal must be removed from mesio vestibular root canal
  3. Patency must be recovered in all 3 blocked canals in order to shape, clean and fill those to the apex

Filed Under: Dental operative microscope and retreatment, Extreme endo clinical cases, General, Post and core build ups, What's new?, Dealing with broken instruments removal, Dealing with ledges and apical zip Tagged With: Dental operative microscope, Embedded pulpstones, endodontic microscope, endodontic procedure, Endodontics, Endodontist, microendodontics, Microscope, Pulp, root canal procedure, Root canal system calcifications, Root canal treatment

Root Canal Procedure on a Second Molar Presenting Adherent Pulpstones and a Dilacerated Curve

March 2, 2012 By Dr Pierre Pizem Leave a Comment

Curved Canals, Dilaceration, Root Canal Treatment Pre-Therapy 29537-1Curved Canals, Dilaceration, Root Canal Treatment Per-Therapy 29537-1

Curved Canals, Dilaceration, Root Canal Treatment Per-Therapy 29537-2Curved Canals, Dilaceration, Root Canal Treatment Post-Therapy 29537-1

Root Canal Procedure. Case Study Number 29537.

Filed Under: Curved canals, Dental operating microscope (D.O.M.) assisted R.C.T., Dilaceration, Extreme endo clinical cases, NEW CASES, Pulp stones (denticles), Root canal systems calcifications, What's new?, D.O.M. versus partially calcified systems Tagged With: Adherent pulpstones, dilacerated curve, dilaceration, Embedded pulpstones, Free pulpstones, opmi proergo, Opmi Proergo microscope, Pulpstones, root canal procedure, treatment protocol

Zeiss Opmi Pro Ergo Dental Operative Microscope VS Complete Stenosis of Root Canal System. Pushing Back the Limits

February 24, 2012 By Dr Pierre Pizem Leave a Comment

Dental operating microscope (D.O.M.), D.O.M. versus completely calcified systems, Root Canal Treatment Per-Therapy 506846-1 

Dental operating microscope (D.O.M.), D.O.M. versus completely calcified systems, Root Canal Treatment Per-Therapy 506846-2  Dental operating microscope (D.O.M.), D.O.M. versus completely calcified systems, Root Canal Treatment Post-Therapy 506846-1

Microendodontic. Calcified canals. Case Study Number 506846

Patient referred for endodontic treatment on this mandibular first molar. Coronal-radicular access was already done but canal entries are embedded in a mass of calcified dentine and could not be found.

Preoperative X ray dental film shows a complete mineralization of both mesial and distal canals coronal third. This is an intricate root canal procedure, because this pre operative condition involves dealing with complete canal stenosis caused by dystrophic calcifications.

Dental operative microscope (Opmi Proergo from Carl Zeiss) and ultrasonic tips where most helpful in locating both mesial and distal canal entries.

Once located, our first instrument in four canals were K files number 06 (second X ray dental film). Then, mesial and distal canals have been shaped and cleaned with the Pro Taper system (Maillefer) and lots of RC PrepTM. They were subsequently filled with gutta percha (lateral and vertical condensation) and Pulp Canal Sealer EWT TM

Third X ray dental film (Clark’s rule) shows all four treated canals.

Amalgam corono apical core build up is shown in last post operative X ray dental film. A crown is planned by patient regular dentist.

Filed Under: Dental operating microscope (D.O.M.) assisted R.C.T., Extreme endo clinical cases, General, NEW CASES, D.O.M. versus completely calcified systems Tagged With: Adherent pulpstones, amalgam, calcified canals, calcified dentine, canal entry location, canal stenosis, clark rule, Coronal-radicular access, corono apical, Dental expertise, Dental operative microscope, Dystrophic calcifications, Embedded pulpstones, Endodontics, microendodontics, mineralization, Pulpstones, Root canal, root canal procedure, Root canal system calcifications, Root canal treatment, True pulpstones, ultrasonic tips

Adherent Pulpstones in a Phantom Rooted Mandibular First Molar (Radix Entomolaris) and the Usefulness of a Dental Operative Microscope (D.O.M.)

January 26, 2012 By Dr Pierre Pizem Leave a Comment

Atypical canal configurations, Radix Entomolaris, Root Canal Treatment Pre-Therapy 500446-1  Atypical canal configurations, Radix Entomolaris, Root Canal Treatment Post-Therapy 500446-1

MicroEndodontics. Case Study Number 500446

A few days ago we were confronted to this three rooted mandibular first molar (Radix Molar or Radix Entomolaris), a rare anatomical variation of teeth, where a third supernumerary root is located distolingually in mandibular molars. Root canal system calcifications and a canal curvature with an “S” form made this endodontic procedure an extremely complex one.

In that specific case, endodontist  operative microscope was most helpful when striving to find the fourth canal entry in distal root, allowing for us not to omit the fourth deeply embedded root canal. This microendodontic case study enlightens how dental operative microscope may assist the practicing dentist into a more secure root canal procedure for his patient.


Filed Under: Atypical canal configurations, Curved canals, Dental operating microscope (D.O.M.) assisted R.C.T., Extreme endo clinical cases, NEW CASES, Pulp stones (denticles), Radix Entomolaris, What's new?, Canal curvature with an 'S' form, D.O.M. versus partially calcified systems Tagged With: anatomical variation of teeth, canal curvature with an s form, Dental operative microscope, Embedded pulpstones, endodontic microscope, endodontic procedure, Endodontist, microendodontics, radix entomolaris, radix molar, Root canal system calcifications

Endodontic Treatment on Mandibular Molar with Calcified Canals and a “J” Type Lesion, a Five Years Follow Up

January 19, 2012 By Dr Pierre Pizem 1 Comment

Dental operating microscope (D.O.M.), D.O.M. versus completely calcified systems, Root Canal Treatment Pre-Therapy 156037-1  Dental operating microscope (D.O.M.), D.O.M. versus completely calcified systems, Root Canal Treatment Per-Therapy 156037-1    Dental operating microscope (D.O.M.), D.O.M. versus completely calcified systems, Root Canal Treatment Post-Therapy 156037-1

Root Canal Procedure with Surgical Operative Microscope.
MicroEndodontic.
Case Study Number 156037.

Pre operative film shows a large bony defect reminding us the alleged pathognomonic “J” type lesion. Still, there was no deep and narrow pocket probing. Root canals are not visible neither  in mesial or distal root (calcified canals)

First appointment post operative X ray dental film shows shaped and cleaned canal system with inserted intracanal calcium hydroxide.

Post operative control X ray film in December 2011 shows a nice healing of surrounding hard tissues. Endo treatment finished on 2007 with surgical operative microscope Opmi PROergo from Carl Zeiss.This root canal therapy attempt once more enlightens the huge advantages of microendodontics and calcium hydroxide therapy in order to save teeth with an apparent very bad prognosis.

Treatment protocol:

First appointment: Opening through metal bridge abutment, gaining access to pulp chamber, adherent pulpstones and embedded pulpstones removal, root canal entries locations, cleaning and shaping, rinsing, drying, intracanal medication insertion and provisional obturation material.

Second appointment: Intracanal medication removal, rinsing and final obturation with Pulp Canal Sealer from Kerr and gutta percha

Endodontic material and equipment:

  • Shaping and debridment instruments: Stainless steel ISO files, Pro taper files (Dentsply)
  • Rinsing solution: sodium hypochlorite 6%
  • Drying: sterile paper points
  • Calcium hydroxide
  • Obturation material: gutta percha lateral and vertical condensation, Pulp Canal Sealer
  • Dental operative microscope: OPMI PROergo microscope from Carl Zeiss

Filed Under: Dental operating microscope (D.O.M.) assisted R.C.T., Extreme endo clinical cases, NEW CASES, Post endodontic treatment outcomes, Pulp stones (denticles), Regeneration of the periradicular tissues, Root canal systems calcifications, What's new?, D.O.M. versus completely calcified systems, Popular Cases Tagged With: Adherent pulpstones, calcified canals, complete root canal stenosis, Embedded pulpstones, endodontic files, Gutta percha, intracanal medication, rc prep, Root canal, root canal procedure, root canal sealer, root canal system, Root canal system calcifications, Root canal treatment, sodium hypochlorite, treatment protocol

OPMI PROergo Dental Operative Microscope VS Completely Calcified Canals

May 4, 2011 By Dr Pierre Pizem Leave a Comment

Dental operating microscope (D.O.M.), D.O.M. versus completely calcified systems, Root Canal Treatment Pre-Therapy 465016-1Dental operating microscope (D.O.M.), D.O.M. versus completely calcified systems, Root Canal Treatment Per-Therapy 465016-1Dental operating microscope (D.O.M.), D.O.M. versus completely calcified systems, Root Canal Treatment Per-Therapy 465016-2Dental operating microscope (D.O.M.), D.O.M. versus completely calcified systems, Root Canal Treatment Post-Therapy 465016-1

Case Study Number 465016

Patient has been referred to to us in order to complete a previously started root canal treatment on completely calcified root canal system. Pulp chamber is obliterated with embedded pulpstones, root canals are not visible on preoperative X ray dental film, these are calcified canals.

Patient is given full knowledge of the possible risks and benefits of such a complex procedure.  Patient is in pain and she wants to keep her own tooth and give an informed consent.

Dystrophic calcifications have been removed from pulp chamber with ultrasonic diamond coated tips. Operative field observation is enhanced with high magnification and coaxial xenon lamp illumination. Once located root canal entries had to be widened in order to progressively regain patency in each root canal. Second X ray shows our first instruments in the root canals, these are K Files 06. Canals have then been shaped to K file size 15 and calcium hydroxide inserted. Following appointment allowed us to finish shaping, cleaning and obturation of the root canal system. Final outcome can be seen on fourth X ray dental film.

Filed Under: Dental operating microscope (D.O.M.) assisted R.C.T., Pulp stones (denticles), Root canal systems calcifications, D.O.M. versus completely calcified systems Tagged With: Adherent pulpstones, calcified canals, complete root canal stenosis, Dental operative microscope, Denticles, Dystrophic calcifications, Embedded pulpstones, Mb2, microendodontics, root canal procedure, Root canal treatment

Zeiss Opmi Pro Ergo Dental Operative Microscope VS Almost Complete Stenosis of Root Canal System

March 17, 2011 By Dr Pierre Pizem 4 Comments

Dental operating microscope (D.O.M.) assisted R.C.T., Dental operative microscope and retreatment, Root Canal Treatment Pre Therapy 17736-1

Dental operating microscope (D.O.M.) assisted R.C.T., Dental operative microscope and retreatment, Root Canal Treatment Pre Therapy 17736-1

Dental operating microscope (D.O.M.) assisted R.C.T., Dental operative microscope and retreatment, Root Canal Treatment Per Therapy 17736-1

Dental operating microscope (D.O.M.) assisted R.C.T., Dental operative microscope and retreatment, Root Canal Treatment Per Therapy 17736-1

Dental operating microscope (D.O.M.) assisted R.C.T., Dental operative microscope and retreatment, Root Canal Treatment Post Therapy 17736-1

Dental operating microscope (D.O.M.) assisted R.C.T., Dental operative microscope and retreatment, Root Canal Treatment Post Therapy 17736-1

Dental operating microscope (D.O.M.) assisted R.C.T., Dental operative microscope and retreatment, Root Canal Treatment Post Therapy 17736-2

Dental operating microscope (D.O.M.) assisted R.C.T., Dental operative microscope and retreatment, Root Canal Treatment Post Therapy 17736-2

 Root Canal Procedure on Calcified Canals.

Case Study Number 317736

Patient referred for pre prosthetic endodontic treatment on mandibular first molar.

Preoperative X ray dental film shows a complete mineralization of both mesial part of pulp chamber and mesial canals as well as a complete stenosis of distal canal(s?)

Dental operative microscope and ultrasonic tips where most helpful in locating both mesial and distal canal entries. First instrument in four canals are K files number 06 (second X ray dental film)

Third X ray dental film (Clark’s rule) shows all four treated canals.

Amalgam corono apical core build up (no post) is planned plus a crown.

Filed Under: Dental operating microscope (D.O.M.) assisted R.C.T., Extreme endo clinical cases, NEW CASES, Root canal systems calcifications, D.O.M. versus completely calcified systems, Popular Cases Tagged With: Adherent pulpstones, amalgam, calcified canals, canal entry location, canal stenosis, clark rule, Coronal-radicular access, corono apical, Dental expertise, Dental operative microscope, Dystrophic calcifications, Embedded pulpstones, Endodontist, microendodontics, mineralization, Pulpstones, Root canal, root canal procedure, Root canal system calcifications, Root canal treatment, True pulpstones, ultrasonic tips

Locating MB2 and DB Orifices with Dental Operative Microscope on Calcified Canals in a Maxillary First Molar

February 4, 2011 By Dr Pierre Pizem Leave a Comment

Dental operating microscope (D.O.M.), Striving for Second Mesio Vestibular (MB2), Root Canal Treatment Pre-Therapy 434426-1Dental operating microscope (D.O.M.), Striving for Second Mesio Vestibular (MB2), Root Canal Treatment Per-Therapy 434426-1Dental operating microscope (D.O.M.), Striving for Second Mesio Vestibular (MB2), Root Canal Treatment Per-Therapy 434426-2Dental operating microscope (D.O.M.), Striving for Second Mesio Vestibular (MB2), Root Canal Treatment Post-Therapy 434426-1

Case Study Number 434426

Patient was refered to us to locate MB2 and DB canal entries with the help of a dental operative microscope. Calcifications had to be removed with ultrasonic diamond coated tips from the pulpal chamber floor in order to expose those canal entries.

Filed Under: Dental operating microscope (D.O.M.) assisted R.C.T., Finding previously underseen MB2, General, NEW CASES, Pulp stones (denticles), Root canal systems calcifications, Striving for second Mesio vestibular (MB2), D.O.M. versus partially calcified systems Tagged With: Adherent pulpstones, calcified canals, Dental expertise, Dental operative microscope, Denticles, Dystrophic calcifications, Embedded pulpstones, Endodontic expertise, Endodontics, False pulpstones, Free pulpstones, Pulp, Pulpstones, Root canal system calcifications, True pulpstones

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