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.
Study Case Number 491047
We have been presented with this previously treated tooth. The canal system has been filled with Sargenti’s paste and a separated past filler still remains in mesial canal. Second image displays a mesial root close up with the broken paste filler reaching it’s apical third.
Patient is informed about these facts and is made aware of the tooth poor prognosis if separated instrument cannot be removed and if Sargenti’s paste cannot be completely removed from canal system. Extraction and implant therapy is considered but patient wants to keep her own tooth. Informed consent is given by the patient.
Pulp chamber is accessed trough amalgam obturation, filling material is then removed with ultrasonic tips and two canal entries (out of three) are localised. Sargenti’s paste is broken into smaller pieces until a softer aspect of the material is found, coronal part of paste filler is exposed and the separated instrument is retrieved and an Xray dental film is taken (Third image). First instrument, a number 06 ISO K file is reaching the apex in fourth X ray image. Fift image is a” calcium hydroxide paste insertion” post operative X ray dental film. Last image (bottom to the right) is a final obturation with Pulp Canal Sealer and gutta percha (lateral and vertical condensation).
Case Study Number 042210
This case shows more than one factor listed in the HIGH DIFFICULTY category: non-negotiated canal, ledge and separated instrument in the apical third of a very sharply curved mesiovestibular root canal, a very long casted post in palatal root canal to remove involving a risk of tooth fracture.
Step 1. Crown and post removal
Step 2. Separated instrument removal and ledge bypass in MB root canal
Step 3. Cleaning and shaping all canals plus Ca(OH)2 insertion for 8 days
Step 4. Obturation of the cleaned and shaped root canal system Last X ray: One year post operative with new post and crown.
Link to the Endodontic Case Difficulty Assessment Form : http://endomontreal.com/wp-content/uploads/2008/09/case-difficulty-assessment-form.pdf