The endodontic dark hole

Fig. 1

Preoperative X-Ray showing massive internal resorption inside the premolar.

Sending patient to CBCT is a must to determine if its perforating the root or not.

Fig. 2

CBCT Examination showed:

• Incomplete deerofing of pulp chamber by previous dentist
• Massive internal resorption
• Level of canal opening is very deep below internal resorption
• Perforating mesially and distally in multiple cuts

Fig. 3

After removing the temporary filling, incomplete deerofing and internal resorption tissues were evident.

Fig. 4

The treatment strategy was to remove all granulation tissues resulted from internal resorption using sodium hypochlorite and activation devices in order to dissolve them all.

Passive ultrasonic irrigation was used to ensure removing all tissues and micro endodontic escavator to remove the bulk of tissues.

Complete cleaning and shaping of all canals after achieving hemostasis which was easy after removing all internal resorptive tissues.

Fig. 5

In this case I preferred to fill the canals by gutta percha and Bioceramic sealer, then close the rest with bioceramic putty to ensure closing all perforation mesially and distally and to use the putty in proper thickness in order to give me proper compressive strength as well.

Fig. 6

Bulk of bioceramic putty placed deep down from middle half of the root where the canals started up till CEJ.

This ensures complete closure of all perforation and compressive strength to equalize the massive loss in tooth structure by internal resorption.

Fig. 7

Post operative X-ray shows very successful and promising treatment and complete adaptation of bioceramic putty in all spaces previously occupied by internal resorptive tissues.