Endodontic Procedure Case Study Number 378415
A Vertucci type VI pulp space configuration can be described as follow: Two canals leaves the pulp chamber, intersect in the body of the root and redivide short of the apex into two separate canals with two distinct foramina (2-1-2).
In this per operative X ray dental film, crossed canals are highlighted with endodontic ISO files within the root canal system. During shaping procedure, only one file at once could pass through the root canal intersection in the body of the root, each root canal branch has been shaped cleaned and filled individually with lateral and vertical condensation.
Preoperative radiological findings that might help us in suspecting such a pulp space configuration: root canal abruptly becomes invisible short of the apex.
Armamentarium: OPMI PROergo dental operative microscope from Carl Zeiss, Rubber dam and rubber dam clamp and frame, Stainless steel K endodontic files, gutta percha and Pulp Canal Sealer, finger plugger.
Dear Dr. Pizem,
Congratulations for great case!
I have a question regarding the obturation. Is it possible to fill canals with lateral condensation in vertucci type VI canals. How should I overcome the problem which occurs when I put both master cones at the same time because one is reaching the apex and the other is binding at the crossing point. I don’t see any solution but to fill the apical third of one of the canals to the crossing point just with sealer and the rest of the canals with gutta-percha but I know that is not adequate. Any chance of filling it correctly with lateral condensation or the method of choice is warm vertical condensation?
Thanks a lot
All the best
Ivan
Dear Dr Mirovic,
You are right, both master cones at once is not the way to do it since they cannot fit together inside main canal. My guess is that warm vertical condensation is also a blind shot approach as it would be with heated plastic carrier gutta obturators, you cannot rely on those techniques to fill both canals at once in a predictable way. ( You are much better off buying a Lotery ticket)
I found that you first need to have perfectly shaped apical branches, then you put one master cone with a snug fit into the first branch and you “lock it in place” with lateral condensation. Then, with a Touch’n heat tip you have to completely remove the gutta from main canal up to the split point, then you have to make sure that the other apical canal branch is free from obturation material. Only then, you can slightly bent the second master cone apical tip and insert it into the other branch, you lock this one to with lateral condensation. Once this is done, you have to remove gutta from main canal to allow for some apical vertical down packing. you will be able to complete the procedure with a heated gutta second wave down packing (I have been using Obtura Gun from Spartan for almost twenty years and it does the job). I hope this could be of some help
All the best
Pierre
Thanks a lot for great advice! It all makes perfect sense!
Just few questions,is it possible that during the downpack of the first canal like you described other apical branch be filled simultaneously, same like the lateral canals are filled. If not, after filling the first branch, if the second master cone cannot fit in place what would you use to remove the excess of obturation material in other apical branch, heat carrier or maybe rotaries?
And also what do you consider by “lock it in place” with lateral condensation?