Patient referred for a pre prosthetic microendodontic treatment on this first mandibular molar. Pulp chamber is almost completely obliterated by adherent calcifications. Root canal entries are also embedded.
Microscope could not be of some use at the beginning of procedure to locate the root canal entries. Thus we estimated the depth and got as close as possible to the pulp chamber roof. In order to estimate the pulp chamber depth as well as its location, the CEJ has been used as the ultimate guide (Using Krasner’s and Rankow’s both law of centrality and law of concentricity). When the approximate depth has been reached with a 330 long shank bur, the troughing with ultrasonic tips began. At this point, despite the magnification root canal entries could not be located because they were still obscured by reparative dentine.
A Variolux NSK hand piece with a Buck 3 from Spartan has been used for that purpose. A careful troughing at the junction of the walls and floor led to the root canal entries.
Then, there has been a lack of patency issue, the first instruments (Mani K files number 06) were not reaching the apical constriction in mesial canals. Some pre flaring allowed them to get to full working length. Shaping with RC Prep, Mani K files and ProTaper Universal. Obturation with Pulp canal sealer from Kerr and gutta.
An amalgam core build up (Nayyar Technique) has been performed before sending the patient back to referring dentist for a permanent crown.
Adherent calcifications do represent a significant challenge in endodontic procedures. According to this study: “as the extent of canal calcification increased one level of intensity, the difficultly in reaching the root canal constriction increased 7 times.”
Link to Krasner and Rankow Laws