Dealing with Dystrophic Calcification in Mesiovestibular Root Canals

Case Study Number 486726

Patient was referred to us with a partial pulpectomy in 3 out of four canals. The case came with a note from referring dentist that MB1 was blocked with a calcification. Patient was in pain and was taking an opioïd analgesic prn (Oxycodone) and prn was high. First appointment we needed to take care of the pain issue by completely removing pulp tissue remnants from palatal and distovestibular root canals. Roots are very long and lots of denticles had to be removed from the canal system. Intervention has been done under observation with a dental operative microscope. A mixture of calcium hydroxide and Iodine was then inserted into those canals. This was the only thing that could be done on an emergency basis. Patient had to come back to address the blockage concern in mesio vestibular root canal.

Patient came back 8 days later, symptoms had completely subsided in a mater off hours post op and patient was able to sleep. On second appointment we have been striving to regain patency in MB1 but failed. Then, since a lot of MB1 and MB2 are merging at the apex, we strived to find MB2 canal entry and we did find it. We were hoping to be able to bypass MB1 blockage and seal both canals at once. But blockage was there too, exactly at the same level as in MB1. Root canals have been sealed with Pulp Canal Sealer EWT. Patient has been advised that the mesiovestibular root canals could not be shaped and cleaned to the apex and that for each missed millimeter from the apex a 14% increase in treatment failure might be expected. Both uncleaned canals parts represented a total length of 20 mm.

This patient is working (as a explosive expert) in a Nickel mine in a very remote area of Northern Canada. Closest dentist is 1000 miles from the exploiting site. He did not want to experiment another blow up of this kind up there, so he decided to come back for a corono apical amalgam, an apicoectomy and a MTA retrofilling on MB1 and 2 before going back to work. Crowning was done by his own dentist.

(The very same dentist asked me to do the core build up in amalgam)