Root Canal Procedure. Case Study Number 492626
Patient is having an AAA with a necrotic pulp, an extensive deciduous restoration and a huge tooh decay on distal aspect of this first maxillary molar (Some of us might think: “you don’t have to worry it is dead”).
Dystrophic calcifications are obliterating the root canal system and we can expect to strive for a second mesiovestibular too. An extreme curvature is also present in distovestibular root canal.
Prior to the initiation of treatment, an estimate should be made as to the degree of curvature of the canal to be treated. For making this determination merely view the curved canal as having two segments, one extending from the floor of the chamber down the long axis of much of the coronal two thirds of the root and the second from the apex of the root extending back to the occlusal through the apical third of the root. These two lines will intersect and form four angles. The interior angle is the estimate of the degree of the canal curvature. In this specific case, distovestibular root degree of curvature has an estimated 120 degree. Such an estimate is of mesiodistal curvature only and does not take into consideration any buccolingual curvature. The method for making this determination has ben first described by Schneider and then Jungman et al.
This present description of Schneider method is from Franklin S. Weine in his book: “Endodontic therapy” Fourth edition pp 314-315
Carl Zeiss Opmi Proergo dental operative microscope was of a big help in locating both mesiovestibular and distovestibular canals entries, I am using the Pro Taper Endodontic files System from Maillefer for preparation of canals as they are doing very nicely in extremely curved canals. Intracanals treatment procedure is a calcium hydroxide as a medicament (Third x ray from left) since there is a lot of intracanal exudation. Canal filling method: master gutta-percha cone, lateral condensation for the first wave, warm gutta percha for the second wave. Pulp Canal Sealer as the root canal sealer. Amalgam filling has been replaced by a composite filling, because patient wanted to wait a bit for his dental insurance to kick back in. Patients regular dentist will do crowning as soon as possible after that.
Wow ! Very few practitioner dare to undertake such an intricate endodontic procedure. This can be described as an extremely difficult case and the outcome is really amazing! This patient will most probably never need to have his tooth extracted and replaced by an implant which could have cost him an extra 3500$ to 4500$. In fact, besides tooth fracture, extraction following endodontic treatment can happen in a short to medium term when standards of care cannot be met. Pierre, you are one of the most highly skilled practitioner in endodontics I ever met. I will definitely keep on referring my own difficult clinical cases to you.Keep on the good work!