endomontreal

An endodontist case report. Microendodontics case study number: 511536

Sixty years old patient presenting with an abscessed mandibular molar. Diagnosis: Persisting disease after (25 year old) root canal treatment. A crown and two post removal where necessary in order to gain access to root canal system for retreatment. 

Only two apointments required to save that tooth:

First apointment: Crown and post removals plus root canal filling retrieval and calcium hydroxide insertion as a medicament. 

Second apointment: Calcium hydroxyde removal, irrigation, drying, final canal obturation gutta percha and Pulp Canal Sealer. Provisional filling material: Clip (not radiopaque) from Voco. 

Tooth is now symptom free and it is now ready for a post and a PFM crown.

A complex root canal retreatment does not have to mean extraction and replacement by a dental implant. A research study by Farzaneh et al. on treatment outcome in endodontic found an orthograde root canal retreatment success rate of 93% . (Farzaneh M., Abitbol S., Friedman S. Treatment outcome in endodontics: The Toronto Study. Phases I and II: Orthograde retreatment. J Endod 2004; 30(9):627-633)

This is a case where, based on the X ray image of a "J" type lesion in combination with a deep narrow periodontal probing, one could easily think of a cracked tooth. However, when observing under high magnification, no crack could be seen from within the root canal mesial wall. This J shaped radiolucency was in fact a narrow desmodontal sinus tract originating from an endodontic infection. Saving that tooth implied a retreatment, a ledge bypass and a few calcium hydroxide dressings replacements. As shown on those control post operative X ray images, a slow but complete periradicular tissues regeneration occured. In this case study, even a CBCT 3D imaging would have shown a deep narrow bony defect that could have misled the practionner to conclude the presence of a cracked tooth. Direct observation under a dental operative microscope showed us otherwise, proving once more how micro dentistry is elevating endodontic care to a higher level. 

(Case 34571514)

Pre-operative X ray film shows symptomatic maxillary right premolars. Four years after retreatment, recall radiographic follow-up (above) shows complete healing. Teeth are still asymptomatic and functional in 2010. 

Silver points have been present in root canals for 25 years, sealer in apical region is long gone due to coronal "macroleakeage", this allowed for silver points to come into contact with tissue fluids and a huge amount of corrosion occurred. "Corrosion products such as silver sulfide, chloride, sulfate and carbonate not only occurs on the point itself but also in dentine and within the adjacent periapical adjacent soft tissues" Pocket atlas of endodontics by Rudolf Beer,Michael A. Baumann,Andrej M. Kielbassa 

This spreading of silver points corrosion products and the important deterioration of root canals walls in the apical region by tooth decay explains why root canals had to be enlarged to a number 80 endodontic file.

Microscope allowed us to find the previously lost pathway to the apex. This casted post has been adapted to patient own previous bridge.

A 5 years follow up X ray of lower left molars and second premolar

Lower left first molar

This is a case where, based on the X ray image of a "J" type lesion, and on a deep narrow periodontal probing, one could easily think of a cracked tooth. The microscope showed us otherwise. No crack could be found under microscope observation. As shown on those VRFs, slow but complete periradicular tissues regeneration followed root canal retreatment (which implied a few calcium hydroxyde dressings replacements). This J shaped radiolucency was in fact a narrow desmodontal sinus tract. 

Root canal procedure, case study number 1

First premolar was having an under fill in its distovestibular root canal. Meaning that one small diameter gutta percha point was floating in a canal with a much wider diameter. This available space allowed for a wonderful bacteria colonization which made the patient experiencing an A.A.A. Second premolar was having a root canal filling half way down the canal creating another A.A.A. First molar had a necrotic pulp allowing for another A.A.A. Second molar was having a filled root perforation. This was a rather explosive situation. Fiberglass reinforced composite posts had to be removed in order to allow for endodontic retreatment, calcium hydroxide dressing in root canals helped to stop abundant exudation. An apical ledge was also present in first premolar distovestibular root canal and had to be bypassed. Root canals were filled with condensed gutta percha and Pulp Canal Sealer as a root canal sealer. Casted post were chosen to replace fiberglass reinforced composite posts. 

6 months post operative control X ray film showed good bony repair. Teeth were completely asymptomatic.

1 Broken instrument in palatal root canal

2 Calcified root canal

3 Broken instrument removed under the high magnification of dental operating microscope(DOM). A No 8 ISO file reaches the apex.

4 Completed root canal.

Multiple portals of exit in distal root and severe curves in mesial root in a mandibular second molar. Refering dentist asked us to restore the tooth. Casted gold post and a gold crown with a long bevelled edge margin. Crown and casted post by Dental Ceramic Studio in Westmount.

Multiples puertas(sitios ) de salida en la raiz distal y muchas curvas en la raiz mesial en el segundo molar mandibular(inferior); lo que hace del tratamiento ser mas complicadol. referido al odontologo para la restauracion del diente. Poste moldeado en oro y una corona en oro con un largo biselado marginal. Corona y poste hechos por Dental Ceramic Studio en Westmount (Montreal)