Root Canal revision procedure on a maxillary molar which implied a plastic carrier removal as well as the by-pass of a fractured instrument previously left in the root.
Patient experienced recurrent pain episodes and swelling coming from an infected previously treated root canals on tooth 15. Extraction and Implant surgery was the sole option offered to her until she landed in our office to get a second opinion. Upon radiographic examination, noticing the fact that the bone rarefaction was mostly located on the distal aspect of the root, we suspected an infected lateral canal. Treatment plan was a root canal revision procedure, a new core build up and a crown.
Root canal system has once more been completely cleaned, shaped, irrigated with NaOCl and then filled with an interim Ca(OH)2 paste. Patient came back a few weeks later and symptoms had completely subsided. Not all lateral canals will create such an infection issue but this one did. For that specific reason, I felt I had to find a way to fill this oddly located one for a better outcome. Neither cold lateral or WVC did allow for an adequate filling, thus a new technique was needed.
The technique: Both canals were filled in their apical third with NeoMTA root canal sealer and gutta (cold lateral condensation). The remaining coronal part has been loaded with NeoMTA root canal sealer and I have used a sterile strip of Teflon for its thermoplastic properties, condensing it to make the sealer squirt through the lateral canal. The ”Teflon Hydraulic Condensation Pressure Technique”was born. An amalgam post and core build up has then been placed into the coronal part of the root canal.
Tooth is now asymptomatic and functional, a crown will be the next and final step to prevent that tooth from being extracted.
Post removal and endodontic procedure revision on a maxillary first molar presenting with a complete fracture of palatal cusp as well as a previously omitted MB2. Tooth was also tender to percussion, no deep narrow pocket. Amalgam core has been drilled out around the post head. The Flexipost has been removed with an ultrasonic tip and a P5. MB2 has been located with the help of a dental operative microscope (OPMI PROergo from Zeiss). Endodontic revision procedure instrumentation has been performed with Mani stainless K files and ProTaper Universal (Dentsply). Chelator: RC Prep. PUI Irrigation: NaOCl 5%. P5 (Dentsply) Sealer used: Pulp Canal Sealer. Obturation technique WVC. X Ray Sensors used: CareStream Kodak 6100. A replacing casted post has been cemented with RelyX along with a new crown. A 2 years follow up shows both an asymptomatic as well as a fully functional tooth.
On July the 29th 2009, we have been presented with this mandibular second molar. Patient was experiencing pain. This radiographic image showed a huge radiographic J-shaped lesion in the mesial aspect of the mesial root. Back then, according to some experts, this type of lesion along with a deep narrow probing was considered as a pathognomonic sign of a vertical root fracture. Since vertical root fracture has a hopeless prognosis, standards of care would have commanded its extraction. In the presence of such a periradicular tissues loss, extraction would have also been indicated in the event we were dealing with a periodontal infection.
Still, what if we were dealing we an endodontic infection? If this was the case, an endodontic revision (endodontic retreatment) would suffice to preserve this tooth. The decision of extracting or saving that tooth has been based on a foundation of sound diagnosis, as we opened the existing PFM crown to confirm the presence of a crack which we could not find.
An endodontic revision which implied an interim calcium hydroxide has proven to be the correct approach, no dental implant needed here.