endomontreal

Case study in microendodontics number: 506846

Patient referred for endodontic treatment on this mandibular first molar. Coronal-radicular access was already done but canal entries are embedded in a mass of calcified dentine and could not be found.

Preoperative X ray dental film shows a complete mineralization of both mesial and distal canals coronal third. This is an intricate root canal procedure, because this pre operative condition involves dealing with complete canal stenosis caused by dystrophic calcifications. 

Dental operative microscope (Opmi Proergo from Carl Zeiss) and ultrasonic tips where most helpful in locating both mesial and distal canal entries.

Once located, our first instrument in four canals were K files number 06 (second X ray dental film). Then, mesial and distal canals have been shaped and cleaned with the Pro Taper system (Maillefer) and lots of RC PrepTM. They were subsequently filled with gutta percha (lateral and vertical condensation) and Pulp Canal Sealer EWT ^TM

Third X ray dental film (Clark's rule) shows all four treated canals. 

Amalgam corono apical core build up is shown in last post operative X ray dental film. A crown is planned by patient regular dentist.

  A new Dental Operative Microscope (D.O.M.) assisted root canal treatment in a calcified maxillary second molar. Case study in microendodontics number: 506317

Radiographic findings: Dystrophic calcifications in the whole canal system are completely obliterating the pulp chamber. It can be expected that the root canal entries are completely embedded in a mass of adherent pulp stones. 

Endodontic procedure problem number one to solve: Locating all four root canal entries without lateraly perforating the root and without destroying to much sound tooth structure in order to keep tooth restorable.

Endodontic procedure problem number two to solve: Cleaning and shaping located root canals without loosing patency, without breaking an endodontic file and without perforating the root. 

Thus, the difficulty level of this endodontic procedure can be considered as very high. A few years back, when there was no surgical operating microscope in our dental practices and only a handfull of daring pioneers in microendodontics, removing this tooth and replacing it  by an implant supported crown would have been a good option to consider in most instances. 

Times have changed. In order to save that tooth, calcified dentin must be carefully removed with long thin ultrasonic tips under the high magnification of dental operating microscope (OPMI PROergo from Carl Zeiss). No rapid technique exists for dealing with calcified root canal system. Root canals has been shaped and  cleaned with Protaper endodontic files and 06, 08,10  K in combination with chelating agent (RC PREP). Canal system has then been filled with Pulp Canal Sealer and Gutta percha laterally and vertically condensed. Provisional filling material: Cavit ^TM.

 Case study number: 495336

Symptoms: Acute pain to pressure, patient is eating on the opposite side. Root canal was done three years ago. (X ray image number one)

Tooth root canal system has been retreated ( reshaping and cleaning) and calcium hydroxide paste inserted as an intracanal medication (x ray image number two), symptoms subsided.

A week later, final root canal obturation with gutta percha and pulp canal sealer completed the root canal procedure, an amalgam post and core build up was done during the same appointment to seal coronal part of the tooth. (X ray image number three)

Six months recall shows a complete healing (X ray image number four). Patient's dentist can prepare the tooth as an abutment to receive a crown.

Endodontic procedure case study number: 378415

A Vertucci type VI pulp space configuration can be described as follow: Two canals leaves the pulp chamber, intersect in the body of the root and redivide short of the apex into two separate canals with two distinct foramina (2-1-2).

In this per operative X ray dental film, crossed canals are highlighted with endodontic ISO files within the root canal system. During shaping procedure, only one file at once could pass through the root canal intersection in the body of the root, each root canal branch has been shaped cleaned and filled individually with lateral and vertical condensation. 

Preoperative radiological findings that might help us in suspecting such a pulp space configuration: root canal abruptly becomes invisible short of the apex. 

Armamentarium: OPMI PROergo dental operative microscope from Carl Zeiss, Rubber dam and rubber dam clamp and frame, Stainless steel K endodontic files, gutta percha and Pulp Canal Sealer, finger plugger.