Patient had pain on this first maxillary molar for the last 12 months. She had been sent for a consultation with a periodontist who performed a root planning because there was abundant bleeding and pain upon probing. Afterward, bleeding did stop and pain subsided. Tooth had been prepared for a crown, however, on the day of permanent crown cementation the same pain reoccured. As it was unclear whether the pain could stem from a crack or an MB2, the patient came to us for a consultation. A crack would mean that the tooth would likely have to be extracted.
Retro alveolar pre operative X ray did not show any peri apical bone rarefaction and there was no deep isolated pocket upon probing.
A CBCT 3D Scan was taken. Both coronal and sagittal plan showed a peri apical bone rarefaction on mesio vestibular root. Axial plan showed the second mesio vestibular root canal. No bone rarefaction on disto vestibular root neither as on the palatal root. Thus it was decided an elective root canal revision was to be performed on mesio vestibular root alone.
Since the landmarks have been removed with crown preparation, the provisional crown was removed to limit the risk of excessive tooth destruction. A conservative access cavity was carried out through the composite core build up. Under high magnification, the search for the omitted second mesio vestibular was performed with troughing with a Buc 3 diamond coated ultrasonic tip from Spartan. Once uncovered, a Mani K file number 06 could easily make it to the foramen, draining some pus.
Root canal has been shaped and cleaned with Mani K files and ProTaper Universal NiTi. PUI and NaOCl 5% . Interim Ca(OH)2 for 8 days.
Symptoms subsided completely and root canal was completed.
It cannot go unsaid that it was due to both Dental X Ray Scanner and dental operative microscope that we were able to further explore the patient’s root canal system which ultimately led to saving the tooth. Without such technology, even the most skilled professional would be limited in their options and resort to considering tooth extraction.