Managing a slightly calcified maxillary molar: Step by step with the Smart Endo Kit
25/10/2021
Xavier-Fructuós Ruiz
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Pulp canal obliteration or calcific metamorphosis is a pulpal response to trauma characterized by a rapid deposition of hard tissue within the canal space. It can occur as a result of chronic trauma like attrition or abrasion. In cases where endodontic treatment is needed, canal location and further instrumentation presents a great challenge to the clinicians.
Fig. 1
A 60-year-old patient came into the clinic with lingering pain when drinking cold beverages and chewing.
The clinical examination revealed a right maxillary molar with a fractured cusp. The patient revealed that the tooth had broken 2 months ago. Furthermore, the patient presented moderate tooth wear as a consequence of bruxism. The tooth responded painfully during the cold test and percussion was positive.
The radiographic examination showed a slight pulp chamber obliteration and a periapical radiolucency in at least 2 of the 3 roots.
The final diagnosis was irreversible pulpits and symptomatic apical periodontitis.
Canal inspection and location was done together with the Deppeler’s mirror and Explora, which results in an excellent tool for detecting canals. Especially for locating the 2nd mesiobuccal canal which is one of the most prevalent missed canals after endodontic treatment. The use of ultrasonic tips and microscope is mandatory to succesfully locate this canals. Moreover, its instrumentation is also challenging due to its narrowness.
Fig. 2
The working length determination radiograph showed the presence of an independent 2nd mesiobuccal canal.
Multiplo which can be attached to the mirror, helped us to mixture our cement (AHPlus) where guttapercha cones were embedded. Moreover, its ruler allowed us to measure the cones length.
Fig. 3
Guttapercha cone fit radiograph
Continuos wave of condensation technique was used to obturate the root canals. The use of PrexoM allowed us to compact the gutta-percha in a safer and predictable way.
Fig. 4
Postoperative radiograph
Conclusions
The Smart Endo Kit from Deppeler combines the best ingredients for a successful Endodontic treatment. The mirror provides an excellent vision of the operative field while having a perfect size. Explora makes your life much more easier in terms of canal exploration. Its small tip allows the clinician to locate very precisely the different root canals, especially in calcified molars and the famous mb2, as in this case. Multiplo, which can be attached to the mirror, help us to mix our root canal cement while measuring our gutta-percha cones to the desired length. Finally, Prexo M, with its double sized tips, allows us to compact guttapercha from thinner to wider canals in a clean and predictable way.
Bibliography
1. Martins Jorge N.R., Alkhawas Moataz Bellah A.M., Altaki Zaher, et al. Worldwide Analyses of Maxillary First Molar Second Mesiobuccal Prevalence: A Multicenter Cone-beam Computed Tomographic Study. J Endod 2018;44:1641-49
2 G Plotino, CH Pameijer, NM Grande, F Somma. Ultrasonics in endodontics: a review of the literature. J Endod 2007;33:81–95.
3 PS McCabe, PM Dummer. Pulp canal obliteration: an endodontic diagnosis and treatment challenge. Int Endod J 2012;45:177–97.
