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Upper Premolar Endo with adequate access

Few cases are straight forward, we just have to be careful not to create some mess in excitement. 58 years female came to our clinic with complain of hot and cold sensitivity in her right upper back tooth. She also complain of food lodgement in same tooth and pain after that. She had medical history of arthritis.

Few #root_canal_treatments and #crowns_bridge work in mouth. In case of arthritis, I try to complete the procedure as fast as possible, because patient tend to get tired faster and opening mouth for too long can be very painful. Also good quality bite-block with mouth not fully opened/ partially opened make patient comfortable.

C/E: Decay in tooth #14. Cold test: +ve Crowns in tooth 15 and 16 done few years back.

R/E: Carious lesion, in tooth #14, involving pulp. RCTed 15 and 16 with broken instrument in DB canal of #16 Now the question is, how these RCTs survive!

Here is the video of caries excavation with diamond bur. Long shank bur with smaller mirrors are my choice while working under magnification as it proves me very good accessibility and visibility.

After the pulp exposure or after entering pulp chamber, I shift to #Safe_end_bur, very easily available as #EX-24 or #EndoAccess by DentSply. It help to extend the cavity without fear of pulp floor cutting or perforation.

For mechanical preparation, #Edge_endo files were used here.

While working through #microscope, we have to work under #indirect_vision most of the time. If you notice in this pic, how we can limit ourselves to working length watching in mirror/ with indirect vision.

After complete #shaping_and_cleaning of both the canals, time to check cone fit and working length.

Usually, I do not shoot working length x-ray. I believe on my #apex_locator for working length. I shoot an x-ray with files only when I'm doubtful.

I prefer to use 2% paper points for drying canals even after I finish almost preparation at 4% taper. Using 2% paper points helps me in confirming #working_length with #paper_point_method. If my preparation is not adequate then 2% paper point will easily cross apex as canal prep is 4%.

Technique of choice for #obturation is #warm_vertical_compaction, where we use compact warm GP with the help of pluggers.

Citric acid can be used for cleaning the ZnOE sealer residue. Best is to use any sandblasting device.

Restoration was finished and polished after rubber dam removal.

This was quite easy case. I tried to conserve as much as tooth structure by making small access. This way we can avoid post saving even more tooth structure.

Thank you for your valuable time. Comments and suggestions are welcome. Dr. Neeraj Narang #MicroDentistryIndia

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