Multiple Difficulties

Sometime a tooth has many difficulties and pitfalls when it comes to root treatment, making the outcomes uncertain. The case here has difficulties of access and isolation due to position and subgingival decay, a second mesio-buccal canal (often impossible to detect without a surgical microscope) and severe curvature of the roots.

A pre-endodontic tooth restoration has been done to avoid per and post operative leakage (1)

The use of a surgical microscope enhanced the search of a present fourth canal, hard to detect without magnification (2), modern rotary instruments (3, 4) along with the latest irrigants activation devices (5) and obturation methods (6), make success in these cases more achievable

Let us help with the complex underlying difficulties and return the patient to your care for the pleasure of the final restoration

(1) Heydrich RW. Pre-endodontic treatment restorations. A modification of the ‘donut’ technique. J Am Dent Assoc. 2005 May;136(5):641-2

(2) Buhrley LJ, Barrows MJ, BeGole EA, Wenckus CS. Effect of magnification on locating the MB2 canal in maxillary molars. J Endod. 2002 Apr;28(4):324-7.

(3) Kiran S, Prakash S, Siddharth PR, Saha S, Geojan NE, Ramachandran M. Comparative Evaluation of Smear Layer and Debris on the Canal Walls prepared with a Combination of Hand and Rotary ProTaper Technique using Scanning Electron Microscope. J Contemp Dent Pract. 2016 Jul 1;17(7):574-81.

(4) Cheung GS, Liu CS. A retrospective study of endodontic treatment outcome between nickel-titanium rotary and stainless steel hand filing techniques. J Endod. 2009 Jul;35(7):938-43.

(5) Duque JA, Duarte MA, Canali LC, Zancan RF, Vivan RR, Bernardes RA, Bramante CM.Comparative Effectiveness of New Mechanical Irrigant Agitating Devices for Debris Removal from the Canal and Isthmus of Mesial Roots of Mandibular Molars. J Endod 2016 Dec (Ahead of print)