Patient came in our office with this very well conducted root canal (Left picture). The tooth had a radiolucid kind of filling for one year and was still symptomatic. The patient was experiencing a daily constant nagging pain to an extreme severe pain during last two flights take off.
Careful examination under high microscope magnification helped us in locating a very discrete purulent leakage on pulpal chamber floor in the mesio-buccal root area. After 60 minutes of intensive labor work under full strength microscope magnification the MB2 canal access has been fully exposed.
It was located under a 3 millimeter thick layer of sclerotic dentin, thus well below pulpal floor level. It took another 20 minutes to clean and shape this canal to the apex.
Since a purulent exsudat was present, a Ca(OH)2 dressing was left in place for ten days. The canal was then obturated with Pulp Canal Sealer and a Shilder-Yu approach for packing Gutta Percha (Picture on the right). Tooth is now completely asymptomatic.