Complexity of the root canal system anatomy

Fig. 1

The 40 years old patient was referred to our office by his general dental practitioner for endodontic retreatment. 

He complained about pain and discomfort associated with his upper left canine. 

The preoperative radiographic showing lateral lesion related to the tooth, short fill obturation and metal screw. 

Fig. 2

After local anesthesia administration, multiple isolation was applied  with rubber dam by using two small wing clamps. 

Fig. 3

Clinical image after remove all the composite around the screw. 

Fig. 4

Clinical image after remove the screw. 

Fig. 5

Fig;5

In this case the effect of the good irrigation is undeniable. As shown, this was the irrigation protocol that relied on a group of irrigating materials in an orderly sequence to ensure good chemical cleaning of the root canal system, as each of this materials have a specific function.

Sodium hypochlorite 5,25% ( NaOCl ): the main irrigating solution used to dissolve organic matter and kill microbes effectively (3)

Ethylenediaminetetraacetic acid (EDTA): is needed as a final rinse to remove the smear layer.(12-15) But it has been used in this protocol more than once to ensure that the dentinal tubules are open to grantee that NaOCl well reach every point of root canal system.

saline: used between these two irrigants to avoid the chemical interaction between them(4)

It was necessary to guarantee the safety and not to pass any of these materials beyond the root apex, also a Gauge 30, double side vented irrigating needle was used to deliver the irrigating material to each canal in depth shorter than the working length by 3 mm.(5)   

The activation of irrigant was done by using an ultrasonic activator, the duration of each activation last for 20 sec.(6)

The image shows the tooth immediately after sodium hypochlorite activation.

Fig. 6

Clinical image and radiographic image show the cone fit. 

Fig. 7

The obturation done with modified hydraulic obturation with premixed Bioceramic cement. 

Fig. 8

Single appointment root canal retreatments presented a favorable success rate. Only preoperative lesion size had a significant effect on on the outcome where the lesions small than 5mm performed significantly better healing(7).  

Clinical image after complete the obturation in single appointment. 

Fig. 9

Restore the tooth with a direct composite restoration in the same appointment. 

Fig. 10

Anatomical abnormalities of the root canal system are frequently seen in specialist endodontic practice, and represent a challenge to be faced with skill and thoroughness, beginning with an accurate diagnostic phase and devising the most appropriate treatment plan. Fortunately, much progress has been made in endodontic research thanks to technological advances and the evolution of higher performance instruments, which now consent even very complex cases to be resolved with relative ease(8).