Management of anatomy in a first tricky premolar (Deep Split)

Fig. 1

Initial situation.

Pulp diagnosis: pulp necrosis, chronic apical abscess.

Fig. 2

Pre-op X-Ray 

DME and working length and confirmation of electronic apex locator reading.

Fig. 3

Sodium Hypoclorite in action

Fig. 4

Shaping up to 45.04, irrigation activation and 5.25% sodium hypochlorite.

Fig. 5

Placement calcium hydroxide followed by a temporary material by two weeks.

Fig. 6

After two weeks, the sinuous tract disappeared completely, a good sign.

Fig. 7

Placement of rubber dam, elimination of calcium hydroxide by ultrasonic activation and irrigation.

Fig. 8

Cone fit.

Because of the position of the gutta-percha cone, I realized the possibility of an extra canal

Fig. 9

I placed a rotary file together with the gutta-percha and the entrance of another canal was observed.

We determine the working length with the apex locator and instrument with rotary files.

Fig. 10

Down pack, it was impossible to place two gutta-percha points through the very split and deep canal.

AH plus sealer.

Fig. 11

I made a deeper down pack of approximately 3 mm and with the soft gutta-percha I compacted towards the opposite side of the canal.

Fig. 12

Once the two canals are sealed, the next step is back filling, with small increments in order to avoid spaces.

Fig. 13

Final Xray

Fig. 14

Obturation done.

Clean the excess of gutapercha and sealer is a very important step in order to do a correct adhesive protocol step.

Fig. 15

Endo A-Z