A new Dental Operative Microscope (D.O.M.) assisted root canal treatment on a maxillary second molar with calcified canals.
MicroEndodontics. Case Study Number 506317
Radiographic findings: Dystrophic calcifications in the whole canal system are completely obliterating the pulp chamber. It can be expected that the root canal entries are completely embedded in a mass of adherent pulp stones.
Endodontic procedure problem number one to solve: Locating all four root canal entries 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 canals without loosing patency, without breaking an endodontic file and without perforating the root.
Thus, the difficulty level of this endodontic procedure can be considered as very high. A few years back, when there was no surgical operating microscope in our dental practices and only a handfull of daring pioneers in 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. 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: Cavit TM.