According to the Canadian Academy of Endodontics, when having to treat a tooth presenting with an exceptionally complicated preoperative condition, achieving a predictable outcome would be challenging for even the most highly skilled practitioner.
Treating a second mandibular molar presenting with a severe pulp canal obliteration such as this one did represent an endodontic procedure challenge when it came to locating the four root canal entries..
Here are the steps I followed to locate all four canal entries:
First, do not count on the floor map because you won’t have any due to the adherent calcifications obliterating the pulp chamber. Try to locate and uncover the less obstructed part of the pulp chamber,
then locate the ML root canal entry by throughing (3 to 4mm deep) the sclerosed dentine which is darker than primary dentine.
Make sure that he canal is patent to length and shape it to F2.
Third step locate the MB root canal entry using ML as a landmark and shape it also to F2. Remember, no floor map, thus, those 2 shaped mesial canals will serve as landmarks to recreate in your mind the floor map and help you locate the two distal root canal entries.
Glide path with Mani K files and chelating agent (RC Prep). Shaping with Protaper Universal. Final obturation with Pulp Canal Sealer from Kerr and Schilder’s warm vertical condensation technique.
Dental operative microscope and ultrasonic tips are mandatory. Allow yourself a sufficient amount of time to perform such procedures.
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