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ePaper created 2016-01-20, 13:53:08 | version 1.38.0
I 19 case report _ root canal position and anatomy complications I roots1_2015 had been removed and the exact working length had been determined using the Apex ID apex locator (Axis, SybronEndo, Fig. 5), the canals were shaped following the SM sequence in TF Adaptive mode to theworkinglength,andIusedtheEndoVacirrigation system (SybronEndo, Fig. 6) with cold physiological salineinordertoreducetheinflammationbycooling down the roots. All of the canals were irrigated with the cold saline for at least 20 minutes. The reason I used this technique was to immediately lower the inflammation inside the mandibular canal, which is notwellinnervated.Reducingtheinflammationinside and around the nerve can take a while and I needed to lower it as soon as possible. The canals were kept empty with a cotton pellet inside the access cavity and a hermetic seal on top. I asked immediately for a CT scan (i-CAT, Imaging Sciences International) to be taken in order to study the case. To my surprise, I found that the position of the mandibular canal was different from the con- tralateral one and that it wasincontactwiththeapex of the second molar where the root canal treatment was performed (Fig. 7). The patient was pre- scribed anti-inflammatories and kept under observation. Several days later, his lip was normal in function, but there was still some of loss of sensibility. Thirty days postoperatively, another CT scan was taken (Fig. 8) in order to check the inflammation inside the nerve itself, but during this time we continued to irrigate the canals with cold physiological saline at intervals of three days. Until the patient reported the slow return of sensitivity, I decided to seal the canals, and it was for me the moment of truth, since I knew that I needed to seal the canals to the 00.00 point and place a small puff of sealer at the end too. Carefully ad- justed master cones were placed inside the canals with a very tight tug back. The correct amount of sealer was applied in order to avoid any excess and gentle warm obturation was performed with the Fig. 6 Fig. 10 Fig. 8 Fig. 5 Fig. 7 Fig. 9