An inferior molar managed in two visits
This patient come to my office with severe pain. On examination there was a grossly decayed 46 which was tender on percussion & having no response to cold test . Xray shows a huge periapical lesion. A rct was planned.
Rubber dam was placed then all the caries was removed ,access was made .
There was a pulp stone in access which was removed by ultrasonic tips.
Then access was packed with a teflon tape inside. Now time to proceed for a pre endo build up ,where sectional metal matrix band was used . Distal wall was made by composites,after checking the proximal seal.
Remove the retainer ,band and wedge & give a temporary dressing & send the patient back . Due to time reasons I decided to stop the procedure and to continue the treatment in a second appointment.
In the second appointment canal was negotiated and shaper with rotary sistem, four canals were find ,
Irrigation done by 5.25 % NAOCL % 17 % EDTA & normal saline as a neutral medium .
Activation of irrigants done by PASSIVE ULTRASONIC AGITATION by U files
PLANO fron Style Italiano Endontics was used to organise Guttapercha in sequence as you can see in the pic.
Obturation with warm vertical compaction was performed
Detail of the pulp chamber floor after the canal obturation
CORE BUILD UP was done by composites . Going to place an indirect overlay later on as a permanent prosthesis .
Final xray shows the filling of the four canals and the buid up.
Endodontic therapy is a linear step by step procedure. from the diagnosis to the end all steps are important.
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2. Heydrich RW. Pre-endodontic treatment restorations. A modification of the ‘donut’ technique. J Am Dent Assoc 2005;136:641-2.
3. Hargreaves KH, Cohen S. Pathways of the Pulp.10th ed. St Louis: Mosby; 2010. p. 109.
4. Ingle JI, Bakland LK, Baumgartner JC. Ingle’s Endodontics. 6th ed. Hamilton: BC Decker Inc.; 2008.
5. Omar H, El-Badrawy W, El-Mowafy O, Atta O, Saleem B. Microtensile bond strength of resin composite bonded to caries-affected dentin with three adhesives. Oper Dent 2007;32:24-30.