Please activate JavaScript!
Please install Adobe Flash Player, click here for download
ePaper created 2015-05-29, 13:18:43 | version 1.38.0
case report _ CBCT in diagnosis I _partly obturated palatal and mesiobuccal (MB) root canals and an unfilled distobuccal (DB) root canal; _slightradiolucencyaroundthepalatalrootapex;no distinctive border towards the surrounding maxil- lary bone structure. Thenecessityofanendodonticretreatmentofthe tooth was explained in detail to the patient, who ac- cepted the suggested therapeutic procedure and the general schedule for further appointments. Treatmentprocedure The old amalgam restoration and the phosphate cement base were completely removed, and the cavity walls were additionally prepared to enable clearvisibilityandstraight-lineaccesstoallrootcanal orifices.TheorificesofthepalatalandMBrootcanals had been blocked with obturation material, presum- ably iodine phosphate cement and a gutta-percha cone. Approximately 3mm distal from the orifice of the obturated palatal root canal, another oval, crack- like orifice could be seen, with the appearance of a perforation. Further assessment of the pulp chamber floorwasperformedwith4.5xmagnifyingloupesand the Endodontic Probe Orifice Opener (DENTSPLY Maillefer). Using the probe and a #10 K-file to nego- tiate the flat oval orifice, the presence of a second palatal (distopalatal, DP) root canal was detected. The orifice of the DB root canal was hidden under brownish deposits of tertiary dentine, located about 2mm distal from the obturated MB canal orifice and approximately2mmbuccalfromtheDPcanalorifice. The DB canal orifice was negotiated and slightly widened with the Orifice Opener, ensuring that it could be easily detected in a further procedure. The secondMBrootcanalcouldnotbefoundwithmetic- ulous searching under loupes and the application of a decalcifying solution (17% EDTA). After consultation and receiving the approval of the patient, it was decided to conduct the entire pro- cedure in at least two sessions. First, the root filling material in the MB and mesiopalatal (MP) root canals was removed using rotating NiTi files, ProTaper D1, D2 and D3 files (DENTSPLY Maillefer), and manual H-files (DENTSPLY Maillefer). Further instrumenta- tion of those canals was performed using WaveOne files(DENTSPLYMaillefer)withreciprocatingmotion: the MP canal with black (#40) and the MB canal with red (#25). The working length was determined and checked throughout the entire procedure using an electronic apex locator (RomiApex A-15, Romidan). The DP root canal was then negotiated and a glide path was created approximately 1–1.5 mm shy of the apical foramen using #10 and 15 K-files. The coronal portion was flared successively with #3 and 2 Gates–Glidden drills. The same procedure was per- formedattheDBrootcanal.Clearvisibilityandstraight- lineaccesswereestablishedforallfourcanals(Fig.1). Two intra-oral radiographs were captured from twodifferenthorizontalangleswithaninsertedK-file in each root canal, but only one revealed all four root canals (Fig. 2), showing vague contours of the apical portion of the roots. A calcium hydroxide dressing was applied at the MP root canal and a paper point, soaked with a 2% solutionofchlorhexidine(R4,Septodont),wasleftin theMBrootcanal.Acottonpelletwithchlorhexidine Figs. 5–7_Axial view of the middle level, axial view of the apical level, and sagittal detailed view of tooth #27. I 27cone beam2_2015 Fig. 5 Fig. 6 Fig. 7