A new Dental Operative Microscope (D.O.M.) assisted root canal treatment in a calcified mandibular molar. Microendodontic. Case Study Number 433336
Broken lingual wall, extended deep restauration, patient has been referred for endodontic therapy with the help of a dental operating microscope because of highly calcified canals.
Radiographic findings: Dystrophic calcifications in the whole canal system are completely obliterating the pulp chamber as well as the mesial root canals entries. It can be expected that the root canal entries are completely embedded in a mass of adherent pulp stones.
Root canal procedure is so difficult because of calcified canals that not so long ago, we would have had to remove this symptomatic tooth and replace it by an implant supported crown. Nowadays, with help of a microscope things have changed a lot.
Microscope can help us to solve Endodontic procedure problem number one: Exposing color map of dentin prior to locating root canal entries without perforating pulpal chamber floor and without destroying to much sound tooth structure in order to keep tooth restorable.
Microscope can help us to solve Endodontic procedure problem number two: Location of root canal entries.
Endodontic procedure problem number three cannot be solved by high tech alone, only experience can help: Cleaning and shaping located root canals without loosing patency, without breaking an endodontic file and without perforating the root.
In order to avoid implant therapy, 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 systems. Root canals where 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.
Last X Ray dental film is a post operative control, a crown with a perfect fit is planned by the referring dentist to prevent fracture and leakage.