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Access Through Both a Crown and a Casted Post to Save a Molar

June 6, 2020 By Dr Pierre Pizem Leave a Comment

Planning access cavity through crown as well as a long casted post

Emergency appointment for a recurrent acute pain on top left side. Root canal casted post and crown have been performed on this second maxillary molar one year ago. Patient is 24 years old, cannot eat on that side and he has been prescribed multiple regimen of antibiotics for this issue. No swelling, no mobility, no deep isolated pocket upon probing. Prognosis is good. Decided not to remove the crown because patient wanted to keep it a few more months. Thus, the post has to be drilled of through the crown.

Emergency appointment access to pulp chamber through casted post

An access has been drilled through the crown , through the casted post up to the pulp chamber level. Due to the non precious alloy it was made of, it took 60 minutes with an electric hand piece and quite a few burs to get through this post.

Palatal root canal entry filled with pus and exudate

Blood exudate and pus drained through the palatal root canal entry and patient has ben rescheduled for root canal revision.

Enlarged access through the casted post

Patient came back, tooth was asymptomatic and access through the casted post had to be enlarged in order to locate MB and DB root canal entries

Confirming absence of MB2 with a small field of view CBCT scan
Interim calcium hydroxyde (Metapaste: premixed paste composed of calcium hydroxide with iodoform)
Patient came back after 10 days and Calcium paste has been removed and per operative X Ray confirm a good cone fit check
Asymptomatic tooth, root canal system sealed with Pulp Canal Sealer from Kerr and cold lateral condensation. Nayyar amalgam core build up.. Crown will be replaced in 6 months.

This challenging root canal procedure has been performed by Dr Pierre Pizem , a general practitioner offering endodontic services for the last 28 years. This procedure took him three appointments totalling 4 hours chair side working time in order to save that natural tooth.

Filed Under: General, Dental operative microscope and retreatment, Extreme endo clinical cases, NEW CASES, Post and core build ups, What's new?, Dealing with casted and machined posts removal, CBCT assisted Root Canal Treatment Tagged With: calcium hydroxyde, casted post, crown, dental implant, dental operating microscope, Endodontic expertise, endodontic revision, implant, Mb2, microendodontics, Microscope, nayyar, Pain, prognosis, tooth ache, swelling, core build up, Cone-beam Computed Tomography, casted post removal, emergency appointment, endodontic access, electric handpiece, cone fit

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