Endodontic procedure case study number: 378415

Crossed canals are highlighted with instrument within the system in per operative X ray dental film.

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

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

Only one file at a time could pass through the narrower root canal part in apical third, each root canal branch has been shaped cleaned and filled individually with lateral and vertical condensation. 

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.

Microendodontics case study number: 500446

A few days ago we were confronted to this three rooted mandibular first molar (Radix Molar or Radix Entomolaris), a rare anatomical variation of teeth, where a third supernumerary root is located distolingually in mandibular molars. Root canal system calcifications and a canal curvature with an "S" form made this endodontic procedure an extremely complex one.

In that specific case, endodontist  operative microscope was most helpful when striving to find the fourth canal entry in distal root, allowing for us not to omit the fourth deeply embedded root canal. This microendodontic case study enlightens how dental operative microscope may assist the practicing dentist into a more secure root canal procedure for his patient.

Root canal procedure with surgical operative microscope, microendodontics case number: 156037. Pre operative film shows a large bony defect reminding us the alleged pathognomonic "J" type lesion. Still, there was no deep and narrow pocket probing. Root canals are not visible neither  in mesial or distal root.

First appointment post operative X ray dental film shows shaped and cleaned canal system with inserted intracanal calcium hydroxide. 

Post operative control X ray film in December 2011 shows a nice healing of surrounding hard tissues. Endo treatment finished on 2007 with surgical operative microscope Opmi PROergo from Carl Zeiss.This root canal therapy attempt once more enlightens the huge advantages of microendodontics and calcium hydroxide therapy in order to save teeth with an apparent very bad prognosis.

Treatment protocol:

First appointment: Opening through metal bridge abutment, gaining access to pulp chamber, adherent pulpstones and embedded pulpstones removal, root canal entries locations, cleaning and shaping, rinsing, drying, intracanal medication insertion and provisional obturation material.

Second appointment: Intracanal medication removal, rinsing and final obturation with Pulp Canal Sealer from Kerr and gutta percha

Endodontic material and equipment:

Shaping and debridment instruments: Stainless steel ISO files, Pro taper files (Dentsply) 

Rinsing solution: sodium hypochlorite 6%

Drying: sterile paper points

Calcium hydroxide 

Obturation material: gutta percha lateral and vertical condensation

Dental operative microscope: OPMI PROergo microscope from Carl Zeiss

Case study number: 171516

Nature of pain: Severe pain to cold heat and spontaneous pain

Clinical examination: deciduous amalgam restorations, leakage, thickened PDL

Radiographic finding: long tooth presenting with severe curvature on buccal root canals

Diagnosis: irreversible pulpitis

No MB2 could be found under high magnification of dental operative microscope. Shaping and cleaning performed using ProTaper system (Dentsply), Gutta percha lateral and vertical packing, root canal sealer: Pulp Canal Sealer EWT (Kerr)

What's new on endomontreal.com?

A) Let us start the new year with some words of wisdom from president of the European Society of Endodontics Dr Claus Löst  : "Dental Implants- The better tooth?" on page 2 of the ESE Newsletter:

http://www.e-s-e.eu/pdf/news/7th-ese-newsletter-38.pdf

B) A root canal procedure on a very long keytooth. Case study number 171516

Thanks for visiting this blog on endodontics

We wish you all a happy new year! 

Clinical endodontic case study number: 505146 

A peculiar anatomical variation can be noticed on this mandibular first molar. What appeared to look like hypercementosis on apical aspect of distal root could in fact be a supernumerary root fused to the distal one (Radix Entomolaris). Careful removal of dentine with ultrasonic tips under high magnification of a dental operative microscope helped in locating this extra canal.  

Preoperative X ray dental film shows a "furcation defect" encompassing the entire width of the tooth (no probing). A root canal treatment implying a few Calcium Hydroxyde dressings (and being patient) helped this patient in saving what appeared to be a hopeless tooth.

Last scan shows a seven years post operative control X ray dental film. The four units fixed bridge has been cemented shortly after complete regeneration of periradicular tissues. 

Patient was told seven years ago to remove lower right premolar and replace this tooth by an implant supported crown. Lack of periradicular tissues implied a guided tissue regeneration wich, in turn implied a bone curetage close to the mental foramen. Estimated health risk: A possible permanent nerve paresthesia caused by a curetage or by an implant surgery close to the mental foramen on a patient with a narrow crestal mandibular bone. A possible failure of guided tissue regeneration wich in turn, would impair implant osseointegration (or simply make the implant surgery impossible). Clinical examination revealed a mobility level of 2 and a sinus tract. Our findings on radiographic appearance: a large but a localised bony defect and a tooth that needed a root canal retreatment. Our suggestion to the patient: To put aside the implant surgery and to invest in a root canal retreatment with a few Ca(OH)2 replacements. The patient had to be patient (and faithful) for a few months in order to monitor progressive periradicular tissue healing. Results: Per and post operative control X ray films show a progressive, then complete healing of periradicular bone tissue. In this case, root canal retreatment proved to be a safe predictable way of saving that tooth at half the cost of an agressive implant surgery. Now, 7 years later, the tooth has it’s own casted post, a PFM crown and it’s mobility level came back to zero. And above all, patient is now completely safe from any paresthesia risk.

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This week's new Dental Operative Microscope (D.O.M.) assisted root canal treatment displays an intricate root canal treatment procedure on a mandibular first molar presenting  a very long root canal configuration with calcified canals. This case report number 474446 can be found at:  A root canal treatment on a very long mandibular molar with apical third of root canals not visible on X ray image.

This case report is highlighted with an 8 second video of a rotating 3 D image of a first mandibular molar displaying the complex anatomical variations that can be found in such teeth.

These images and video may be obtained from "The root canal anatomy project" blog and where developed at the Laboratory of endodontics of Ribeiaro Preto dental school- University of Sau paulo by doctor Marco Aurelio Versiani and by doctor Jesus Djalma Pecora. The video displays the complex anatomy of such a root canal in red and gives us a better understanding on how difficult the cleaning and filling tasks of a root canal may be.