endomontreal

Case report in microendodontics number: 500047

Canal curvatures are a challenge to preparation and can be the origin of many technical complications leading to failure of treatment. Canals that curve in the mesio-distal direction are usually readily detected in radiographic dental films. However, as it is the case here, many canals curve also in the bucco lingual direction.  The bucco lingual aspect of this sharp curvature has been displayed using a mesio distal angulation of our X ray cone beam.

Root canal procedure case study number: 492626 

Patient is having an AAA with a necrotic pulp, an extensive deciduous restoration and a huge tooh decay on distal aspect of this first maxillary molar (Some of us might think: "you don't have to worry it is dead").

Dystrophic calcifications are obliterating the root canal system and we can expect to strive for a second mesiovestibular too. An extreme curvature is also present in distovestibular root canal. 

Prior to the initiation of treatment, an estimate should be made as to the degree of curvature of the canal to be treated. For making this determination merely view the curved canal as having two segments, one extending from the floor of the chamber down the long axis of much of the coronal two thirds of the root and the second from the apex of the root extending back to the occlusal through the apical third of the root. These two lines will intersect and form four angles. The interior angle is the estimate of the degree of the canal curvature. In this specific case, distovestibular root degree of curvature has an estimated 120 degree. Such an estimate is of mesiodistal curvature only and does not take into consideration any buccolingual curvature. The method for making this determination has ben first described by Schneider and then Jungman et al. This present description of Schneider method is from Franklin S. Weine in his book: "Endodontic therapy" Fourth edition pp 314-315

Carl Zeiss Opmi Proergo dental operative microscope was of a big help in locating both mesiovestibular  and distovestibular canals entries, I am using the Pro Taper Endodontic files System from Maillefer for preparation of canals as they are doing very nicely in extremely curved canals. Intracanals treatment procedure is a calcium hydroxide as a medicament (Third x ray from left) since there is a lot of intracanal exudation. Canal filling method: master gutta-percha cone, lateral condensation for the first wave, warm gutta percha for the second wave. Pulp Canal Sealer as the root canal sealer. Amalgam filling has been replaced by a composite filling, because patient wanted to wait a bit for his dental insurance to kick back in. Patients regular dentist will do crowning as soon as possible after that.

Case number: 63724 

Irreversible pulpitis, deep carie, deciduous restoration, broken lingual wall. First molar with 4 root canals. Two mesial root canals no longer visible in middle and apical third with a curvature into "C" form. A file number 08 ISO follows a 90 degrees curvature in one of two distal root canals (per op. X ray dental film).

These canals in the distal root are presenting a dilaceration or sudden angular bend, according to Dr John Ide Ingle: "The major problem in these cases is the exploration, hence the pathfinder curve in the instrument". To my opinion, the main problem is the complete files sequence. These curves require much more endodontic expertise to deal with than the mesial root gradual curve.

Pulpitis irreversible, caries profunda,restauracion obsoleta(caduca, en pesimas condiciones), pared lingual fracturada(quebrada). Primer molar con 4 canales radiculares. Dos canales radiculares mesiales no visibles de lejos en tercio medio y un tercer canal radicular con una curvatura interna en forma de "C". Una lima 08 ISO  seguida con una curvatura de 90 grados en uno de los dos canales radiculares distales.

Pre operative film shows a large bony defect reminding us the alleged pathognomonic "J" type lesion. Canals are not visible in mesial root. An impressive soft tissues swelling of adjacent vestibular area was also noted. Endo treatment finished on the 16th of march 2009 with surgical operative microscope (three appointments were needed). Post operative control X ray film (16th of october 2009) shows a nice healing of surrounding hard tissues.

Canal is no longer visible in last apical 2/3 in preoperative Xray film. Post operative X Ray dental film reveals an extreme angle curvature in the canal. A provisional "Richmond style crown" was made immediately after root canal completion.  

Study case number: 124746

En la primera radiografia podemos apreciar una obturacion en contacto intimo con la camara pulpar ocasionando dolor intenso al paciente, Realizando el tratamiento nos damos cuenta que estamos en presencia de un conducto radicular a 90 grados, y por tanto la dificultad de  acceder al conducto y hacer el tratamiento sin perforaciones para tener exito a largo tiempo.  

Numerous denticles in pulp chamber to remove prior to cleaning and shaping of root canal system. This was done with a surgical operative microscope.

Endo with difficult access due to tooth position in the arch, calcified, very long (24 mm) and very sharply curved MB and MB2 on second maxillary left molar.