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Microendodontics with Carl Zeiss OPMI PROergo Dental Operative Microscope. Root Canal Treatment Procedure on a Lateral Incisor with a Calcified Canal

November 17, 2011 By Dr Pierre Pizem 3 Comments

Dental operating microscope (D.O.M.), D.O.M. versus completely calcified systems, Root Canal Treatment Pre-Therapy 501812-1                 Dental operating microscope (D.O.M.), D.O.M. versus completely calcified systems, Root Canal Treatment Per-Therapy 501812-1   

Dental operating microscope (D.O.M.), D.O.M. versus completely calcified systems, Root Canal Treatment Per-Therapy 501812-2               Dental operating microscope (D.O.M.), D.O.M. versus completely calcified systems, Root Canal Treatment Post-Therapy 501812-1

A new Dental Operative Microscope (D.O.M.) Assisted Root Canal Treatment in a Calcified Maxillary Lateral Incisor.
MicroEndodontic.
Case Study Number 501812

Radiographic findings: Dystrophic calcifications in the whole canal system are completely obliterating the pulp chamber as well as the root canal itself. It ca be expected that the root canal entry is completely embedded in a mass of adherent pulp stones.

Endodontic procedure problem number one to solve: Locating root canal entry without lateraly perforating the root and without destroying to much sound tooth structure in order to keep tooth restorable.

Endodontic procedure problem number two to solve: Cleaning and shaping located root canal without loosing patency, without breaking an endodontic file and without perforating the root. 

This is an extreme endodontic procedure. A few years back, when there was no surgical operating microscope in our dental practices and only a handfull of daring (and caring)  pioneers in microendodontics trained by Dr Garry B. Carr (who is an endodontist acknowledged to me as the “father of microendodontics”), removing this tooth and replacing it  by an implant supported crown would have been a good option to consider in most instances. 

Times have changed. In order to save that tooth, calcified dentin must be carefully removed with long thin ultrasonic tips under the high magnification of dental operating microscope (OPMI PROergo from Carl Zeiss). No rapid technique exists for dealing with calcified root canal system. In this specific case ultrasonic tip went off centered creating a groove in canal toward distal, X ray dental film taken during the root canal procedure alowed us to notice this and alowed us to correct the tip orientation before making a perforation. This groove has been filled within the canal itself with Geristore from DenMat. Root canals has been shaped and  cleaned with Protaper endodontic files and 06, 08,10  K in combination with chelating agent (RC PREP). Canal system has then been filled with Pulp Canal Sealer and Gutta percha laterally and vertically condensed. Provisional filling material: ProTemp (A provisional crown with anchorage).

Last X Ray dental film is a post operative control, the referring dentist asked us to make and cement a casted post in order for him to cement a planned fixed crown.

Filed Under: Dental operating microscope (D.O.M.) assisted R.C.T., Extreme endo clinical cases, NEW CASES, What's new?, D.O.M. versus completely calcified systems Tagged With: Adherent pulpstones, calcified canal, calcified dentine, complete root canal stenosis, Dental operative microscope, dentin, dystrophic, endodontic files, Endodontics, Endodontist, garry carr, Gutta percha, Images, microendodontics, Opmi Proergo microscope, pro taper, Protaper dentsply, pulp canal sealer, root, Root canal, root canal perforation, root canal sealer, Root canal system calcifications

Reader Interactions

Comments

  1. Joe Stuart says

    June 7, 2013 at 1:03 pm

    This is a great case. It appears that you did a nice job clinically. How is the patient doing and how long has it been since the case was completed? Thanks.

    Reply
    • Dr Pierre Pizem says

      June 7, 2013 at 1:58 pm

      Thanks for your nice comment, case has been completed on october 2011, patient is still doing fine up until now.

      Reply
  2. Dental Operating Microscope says

    November 28, 2013 at 6:43 am

    Dental Operating Microscope is used for root canal treatment in a calcified maxillary lateral incisor. It is difficult for dentist to work on mouth…I appreciate the job you are doing..

    Reply

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