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.
Root Canal Procedure on Calcified Canals. Case Study Number 513546
First preoperative X ray dental image displays a previously started root canal. This tooth was referred by a clinician who could not locate the four calcified canal entries.
Careful removal of calcification with ultrasonic tips (BUC3) under high magnification, allowed for this root canal treatment to be completed. There is at the present time no other way than the use of a microscope to preserve such a calcified tooth.
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This week's new Dental Operative Microscope (D.O.M.) assisted root canal treatment displays an intricate root canal treatment procedure on a mandibular first molar presenting a very long root canal configuration with calcified canals. This case report number 474446 can be found at: A root canal treatment on a very long mandibular molar with apical third of root canals not visible on X ray image.
This case report is highlighted with an 8 second video of a rotating 3 D image of a first mandibular molar displaying the complex anatomical variations that can be found in such teeth.
These images and video may be obtained from "The root canal anatomy project" blog and where developed at the Laboratory of endodontics of Ribeiaro Preto dental school- University of Sau paulo by doctor Marco Aurelio Versiani and by doctor Jesus Djalma Pecora. The video displays the complex anatomy of such a root canal in red and gives us a better understanding on how difficult the cleaning and filling tasks of a root canal may be.
A New Dental Operative Microscope (D.O.M.) Assisted Root Canal Treatment on Maxillary Incisor with a Calcified Canal.
MicroEndodontic. Case Study Number 73422
Patient has been referred for dental operating microscope assisted root canal. Acute pain on this heavily restored lateral incisor kept the patient awake all night long. Pulpal necrosis and acute apical periodontitis is the diagnosis.
Radiographic findings: Pulp chamber is not visible and root canal is barely visible in its last apical third on preoperative X Ray of this maxillary lateral incisor. This is because dystrophic calcifications in the whole canal system are completely obliterating the pulp chamber as well as two thirds of the root canal itself. It can be expected that the root canal entry is completely embedded in a mass of adherent pulp stones. Diffuse calcifications preclude easy canal entry location.
Problem number one to solve: Creating a pathway to the remaining portion of root canal with patency without perforating the root laterally and without destroying to much sound tooth structure in order to keep tooth restorable.
Problem number two to solve: Locating root canal entrie (which is located very apically in the root canal system) without perforating the root and without destroying to much sound tooth structure in order to keep tooth restorable.
Taking into consideration the fact that root canal system is not visible on pre operative Xray dental film, and being aware of the technical problems that might be expected during the endodontic procedure, an antibiotic therapy (which is going to leave the patient in pain for another two or three days) followed by an apicoectomy with a retrograde MTA filling might have been considered as an option. But, then again for how long? Tooth crown is heavily restored and when the time comes for a PFM, a space for a post is going to be needed anyway. By locating and treating this root canal STAT with calcium hydroxide, pain will subside almost on the spot and canal prep for a post will be obtained by the same token.
Patient is given full knowledge of the possible risks and benefits of such a complex procedure. Patient just wants the pain to stop, he also wants to keep his own tooth. An informed consent is given.
In order to save that tooth, calcified dentin must be carefully removed with long thin ultrasonic tips under the high magnification of dental operating microscope (OPMI PROergo from Carl Zeiss). No rapid technique exists for dealing with calcified root canal systems. Progressive abrasion of dense calcifications both in pulp chamber and root canal led to the canal entry in the last apical third of root canal.
24 mm long root canal has been easily shaped and cleaned with Protaper endodontic files and 06, 08,10 K in combination with chelating agent (RC PREP). Canal system has then been filled with calcium hydroxide for 8 to ten days. It has then been filled with Pulp Canal Sealer and vertically condensed Gutta percha. Provisional filling material: Clip from Voco.
Last X Ray dental film is a post operative control. Casted post and crown are planned for this tooth.
Case Study Number 455336
Irreversible pulpitis, deep carie, deciduous restoration, broken lingual wall. First molar with 4 root canals. Two mesial root canals no longer visible in middle and apical third with a curvature into “C” form. A file number 08 ISO follows a 90 degrees curvature in one of two distal root canals (per op. X ray dental film).
These canals in the distal root are presenting a dilaceration or sudden angular bend, according to Dr John Ide Ingle:
“The major problem in these cases is the exploration, hence the pathfinder curve in the instrument”.
To my opinion, the main problem is the complete files sequence. These curves require much more endodontic expertise to deal with than the mesial root gradual curve.
Pulpitis irreversible, caries profunda,restauracion obsoleta(caduca, en pesimas condiciones), pared lingual fracturada(quebrada). Primer molar con 4 canales radiculares. Dos canales radiculares mesiales no visibles de lejos en tercio medio y un tercer canal radicular con una curvatura interna en forma de “C”. Una lima 08 ISO seguida con una curvatura de 90 grados en uno de los dos canales radiculares distales.