Case number: 63724 

Case number: 6937

Case study number: 63727

Case number: 419134

Phoenix abscess, hypercementosis, completely mineralised apical third of root canal,mobility WNL. A time and RC Prep^TM consuming case. Patient was having a severe gag, X rays were difficult to take. Sorry guys.

Case number 474446

Deep deciduous restorations have been replaced 4 days ago. Patient has been experiencing severe spontaneous throbbing pain for the last two days. Tooth is presenting an irreversible pulpitis following a restoration replacement. 

Radiographic examination shows calcifications in apical third of all root canals, a thickened PDL in furcation and a very long tooth with a severe curvature in mesial root. The two mesial canals are merging in apical third and their length is 27mm.

Calcifications have been removed from pulp chamber with ultrasonic diamond coated tips from Spartan^TM, Endodontic treatment done in one appointment with lots of RC Prep^TM for chelating agent, Pro Taper^TM NITI files, gutta percha and Pulp Canal Sealer^TM . 

Case study number 485946

Symptomatic mandibular molar, patient can't chew on that side. Referred to us for endodontic revision.

First appointment intervention steps:

Coronal-radicular access (access through PFM crown, access through coronal build up) taking great care not to perforate the previously weakened pulpal floor, gutta percha removal, locating DB, regaining patency in calcified distal canals to the apex without perforation or deviation, correcting step in apical third of mesiolingual canal, negotiation of mesial canals, CHX 2% irrigation, CHX 2% left in canal system for one minute, drying canals, insertion of calcium hydroxide dressing, provisional obturation (Cavit)

Second appointment intervention steps:

Removal of Ca(OH)2, CHX 2% for one minute, dry canals, cone fit checking and final obturation with Pulp Canal Sealer and Gutta Percha.

Small sealer overflow is a good warrant of apical seal.

Referring dentist is planning a fixed bridge 37, 36, 35 X. (Patient did not want an implant to replace missing #34)

Case study number: 434426

Patient was refered to us to locate MB2 and DB canal entries with the help of a dental operative microscope. Calcifications had to be removed with ultrasonic diamond coated tips from the pulpal chamber floor in order to expose those canal entries. 

This is a symptomatic mandibular first premolar (bridge abutment) with a "C" shape root canal system. Most C-shaped canals occurs in mandibular second molars but they have been also reported in the mandibular first molar, the maxillary  first and second molars and the mandibular first premolar. This "C" shape first mandibular premolar root canal system is extremely rare. The only orthograde way to endodontically treat this anomalous root is to bring our first K file #06 to the apical third by bypassing what looks like a "mega concretion". Use of the dental operative microscope, sonic and ultrasonic instrumentation is mandatory. Being familiar with access cavity preparation for "C" shape RC through prosthetics, being familiar with cleaning, shaping and an obturation of a mineralized "S" shape root canal is also important. A cone beam tomography would have been most helpful in determining which root canal configuration we were dealing with prior to initiating this RCT and this very same tomo would have helped us in orienting our search for the pathway to the apex, but patient was reluctant to this innovative technology and decided to go for it only if symptoms persisted. Only one single pathway to the apex was found, tooth is now completely asymptomatic. Since we could not confirm this with a tomo, lets hope we were dealing with only one apex. (a type III Vertucci root canal configuration). A close follow up is planed.  

Esforzandose para hallar los caminos hacia el apice contorneando un "mega pulpolito" en  un sistema de canales radiculares anormales.

Este es un primer molar mandibular sintomatico (diente pilar) con un sistema radicular (nervio)  en forma de "C". Muchos canales radiculares en forma de "C" ocurren en los segundos molares pero ellos han sido reportados en el primer molar mandibular(inferior), el primer y segundo molar maxilar(superior), y el primer premolar mandibular(inferior). Esta forma de "C" en el canal radicular del primer premolar mandibular(inferior) es extremadamente raro. La unica forma(orthograde) para tratar endodonticamente de esta anomalia radicular es trayendo nuestro K file #06 hacia el tercio apical contorneando lo que parece un mega pulpolito (piedra). El uso del microscopio dental, instrumentacion sonica y ultrasonica es obligatoria. Estar familiarizado con el acceso a la preparacion cavitaria en forma de "C" a traves una corona, estar familiarizado con la limpieza, dar una forma al canal y hacer la obturacion de un canal radicular mineralizado en forma de "S" es tambien importante. Una tomografia (CBCT) podria haber sido de mucha ayuda determinando cual canal radicular nosotros debemos tratar antes de comenzar, y esta misma tomografia podria habernos ayudado en la orientacion de nuestra busqueda de los caminos hacia el apice, pero el paciente rehusa esta tecnologia innovadora y decide ir solo si los sintomas persisten despues del tratamiento. Solo fue hayado un camino simple hacia el apice, el diente es ahora completamente asintomatico. Desde que nosotros no podamos confirmar esto con una tomo, esperando que nosotros tratamos solo un apice. (un canal radicular de tipo III de Vertucci), un seguimiento cercano del caso es planeado.