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Re-root canal treatment for tooth #46

I always enjoy endodontic re-treatments, as IMHO, If being a dentist I am not able to save the tooth by any means, it is meaningless to be a dentist. But, its not always, we are able to save the tooth. There are always some clinical conditions like #vertical_fractures, no #ferrule, periodontally compromised, etc, where it is impossible to save the tooth. In these conditions we have to extract the tooth and replace it by suitable means.

He, 28 years healthy male patient, was referred to our Karnal clinic by his friend stating they are the best and do the best in patient interest not their own interest. He had pain in right lower back tooth since few day. pain didn't bother him much as it was dull.

He had history of some filling done around 9-10 years back in the concerned tooth. On clinical examination, 46 had amalgam filling and some secondary decay around it & POP+ve. R/E revealed root canal treated 46. There was missed one of distal canal but no periapical lesion associated.

Re-root canal treatment was advised. Here is the pre op clinical picture.

Video showing old restoration and caries removal with long shank diamond.

After access to pulp chamber, it shows complete de-roofing was not done during the procedure and this tooth was doing fine since so 9-10 years. In many cases, there had been pulp tissue present below the pulp stone. It surprises me a lot.

I prefer to use long shank burs to remove caries using smaller mirrors, size 3 (FileyDent). It provides better accessibility & visibility while working.

After removing some secondary decay and GP.

Edge endo files used for coronal shaping. I prefer 20/06 or 25/06 file for coronal flaring, it saves coronal radicular dentin. Coronal flaring files available with most of the brands have very high taper so are not good for tooth.

When GP is adherent to canal wall sometimes deep in the canals. MM sonic 1500 is very good device to remove/ retrieve for such cases. Here is the video for the same:

MM sonic is run at medium frequency, GP and canal wall junction is touched with the file. GP loosens and can be removed with the help of H files.

Many a times GP comes out sticking to MM sonic file, if it doesn't come the can be removed with the help of H files.

MM sonic files are metallic so can be bent too according to location of GP and canal.

This is the main advantage of using #magnification, we can actually see what we are doing. And root canal treatment is no longer a blind procedure.

MM sonic for activation of irrigant, i.e., Sod. Hypochlorite and EDTA

This is how tooth looks after complete shaping and cleaning of canal.

A layer of colored composite, after root canal treatment completion (posterior teeth) is a rule in our practice. Its advantages are:

-We can free the patient after this without risking coronal seal if cavit comes out in between post op restoration appointment.

-In our practice post op restorations are many a times done by associate dentist and if due to any reason they do not apply rubber dam, chances of bacteria entering the canals are nil.

Post op radiographs at different angle helps in visualizing canal anatomy better.

Thanks for your valuable time. Your comments and suggestions are welcome.

Dr Neeraj Narang

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