Dentist Area - Special Case 2

Root Canal Treatment

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The following presents a challenging case of an extremely anxious 36-year old patient who was referred to Smile Clinic dental surgery London and seen by the specialist, Dr Daoudi cosmetic dentist, for assessment and treatment of LL6 and LL7. Both teeth were heavily broken with signs of separated instrument in each tooth (Fig 1).

Different treatment options were discussed with the patient including complex root canal procedure, the need for complex restorative procedure to restore the teeth and the possibility of extraction and the provision of a replacement in the form of a bridge or preferably dental implants. The patient main goal was to save the teeth.

Clinically, the patient was asymptomatic. No pocketing was present and both LL5 and LL8 were restored. On balance the patient agreed to proceed with the root canal treatment with the option to explore implant treatment in the future.

The Treatment:

The use of the rubber dam and the operating surgical microscope was crucial for the success of this case. It helped locating the position of the instrument in each tooth.

Flaring the access into each canal facilitated viewing the instrument.

In case of the LL6, 4 root canals were located. The separated instrument was in the DB root canal. The instrument in the LL7 was positioned in the MB canal.

After locating the instrument, small hand files were used to bypass each instrument. This was helped with the use of copious irrigation and lubricant e.g. EDTA gel.

Once that achieved the use of ultrasonic filing and/or H-files helped removing the instrument. In theses cases there is a risk, however, of pushing the instrument apically as in LL6 (Fig 2).

This happened due to the fragmentation of the instrument into 2 parts. One was retrieved successfully and smaller part was pushed through the canal tip outside the tooth.

As for LL7, H-files were used in a special technique to bind to the separated instrument (Fig 3) and remove it in one piece (Fig 4).

Following shaping and cleaning the root canal system of both teeth using rotary instrumentation, warm vertical technique was used to obturate the teeth (Fig 5).

Upon the completion of root canal treatment, the patient was requested to return to the referring colleague, in a dental surgery London, to restore both teeth. A recommendation of teeth whitening and cosmetic veneers was made to the referring colleague. The patient was happy with the outcome of the provided treatment. Additional cosmetic dentistry was provided by the referring dentist.

Please contact care@smile.uk.net for further information.