Patient with a limited opening of her mouth came for a consultation thinking she may need a root canal on painful mandibular first molar upon mastication.
There was no pain with the Toothsloot biting test, no visible crack under transillumination, tooth responded to cold within normal limits, there was no deep and narrow pocket upon probing but the probing to distal triggered the exact same pain she was experiencing when chewing.
Tooth 37 was missing and the extruded second maxillary molar was filling the space.
Furthermore calcified tooth 27 was not responding to cold test nor to the electric pulp tester.
Patient has been explained that she did not need a root canal on her mandibular molar as she previously thought because the pain she was experiencing came from a traumatized gum when chewing due to the extruded second maxillary molar. However by shaving this maxillary molar which also needed a root canal pain would subside.
On the first appointment 1/3 of maxillary crown length has been shaved and MB as well as the palatal canals have been cleaned and shaped with Mani K files and Protaper universal.
However disto vestibular (disto buccal DB) root canal entries could not be located even under high magnification.
At a subsequent setting, a 3D scan has been done and revealed the position of the root canal entry.
Even with that information in hand, the DB entry was so narrow that it took an extra 60 minutes to locate it with the help of the microscope.