Dr. Charles-Maximilien THI
General Dental Practitioner with an interest in endodontics

SCM ALESIA DENTAIRE
10-12 rue de la Tombe Issoire
FR-75014 – PARIS
FRANCE

Clinical case commented by Pr. Jean-Marie Vulcain

Case presentation:

Lower right second molar #47 has been the source of frequent, acute episodes of pain. A diagnosis of irreversible pulpitis was made. Radiographically there is evidence of caries extending subgingivally in the mesial aspect of the tooth. An Initial Endodontic Treatment is therefore indicated.

The per-operative radiograph shows:

  • Secondary caries below occlusal restoration
  • Some root caries mesially – clinically, the tooth is restorable
  • The root canals appear to converge apically
  • A decrease of the pulp volume
  • Complex root canal path with curves and double-curves
  • Long tooth roots and hence, long canals

Intial Endodontic Treatment

- Local anaesthesia
- Isolation with rubber dam
- Opening of the pulp chamber
- Detection of the canal orifices with the aid of a surgical microscope
- Thorough irrigation throughout the procedure
- Root canal access with Neoniti C1 no. 25/.12 fand then irrigation
- Initial canal scouting using K-files of size #08 – #10 – #15
- Completing glidepath with Neoniti GPS no. 15/.03 and then irrigation
- Measuring the Working Length (WL) using an apex locator
- Preparing the root canals with Neoniti A1 no. 20/.06, then A1 no. 25/.06, and irrigation
- Drying of the root canals
- Calibrated single-cone obturation and direct thermocompaction (McSpadden)
- Post obturation radiograph

Comments

This tooth presented the operator with limited access and fine canals with complex anatomy. The coronal third was accessed using Neoniti C1 no. 25/.12 followed by the creation of a conventional glidepath with K-files #08, #10 and #15. The glidepath was completed using Neoniti GPS no. 15/.03 before completing the shaping with Neoniti A1 no. 20/.06 and no. 25/.06. The postoperative radiograph demonstrates that the natural canal anatomy has been respected allowing complete cleaning, shaping and obturation of the complex canal system