Dental Diagnosis Dilemma

Fig. 1

Preoperative X-Ray not showing enough data and the x-ray looked fine.

Sending patient to CBCT is a must to determine if there is actually a problem or not.

Fig. 2

CBCT Examination showed:

• Missed DB canal split at middle half and separate apex.
• Short ML canal obturation.
• Periapical radiolucency beneath both apices.

Fig. 3

Macro shot of finding the DB canal.

I always try to find the missed canal first and shape it, before removing the GP from other canals.

Using U.S to trough up to middle half at the division level & using full conc sodium hypo to flush out debris.

Catching the canal via DG16 and negotiating it and enlarging it.

Fig. 4

Here you can see the canal very deep down and using this trick its easier to identify and not to slip by mistake into the other canal.

Fig. 5

Here we removed all GP, finished all canals prep and implemented great irrigation protocol to prepare the case for obturation.

Fig. 6

TCA technique is great for these types of cases by placing CM wire files manually then mounting the rotary device to select which canal to prepare.

Fig. 7

Post operative Xray showing 3D obturation to all canals and split.

Using bioceramic sealer and Continous wave obturation technique to maximize the success rate of the case.

Fig. 8

About the author:

Dr Khaled Khalifa

B.D.S. Misr International University

Endodontic Specialist

Course Director “The Endo Formula”

Endodontic Consultant in multiple private clinics

Member of The Royal College of Surgeons England (MJDF)

Member of The American Association Of Endodontics (AAE)

Member of British Association Of Endodontics (BES)

Practice limited to Endodontics