Presentation of the clinical case

The patient was referred by a colleague to complete the endodontic treatment of the necrotic tooth 16. During catheterization, she found only one vestibular canal and it seemed to her that the apices were quite open. She therefore preferred that I carry out the treatment to locate the additional vestibular canal and avoid any risk of overextension of material during obturation.

Image

Image

Figure 1

The CBCT scan reveals the presence of only two canals: one wide buccal and one wide palatal canal. The apex of the palatal root is very open, posing a risk of overfilling during obturation.

Figure 2

Access cavity already prepared by the colleague: refinement of the cavity and relocation of the buccal and palatal canal entries.

Figure 3

Verification of working lengths using K10 and K15 files to confirm measurements taken with the “Apex Connect” apex locator by Kerr.

Figure 4

Validation of working lengths.

Figures 5 to 8

Shaping of the canals with ZenFlex files up to size 35/06 in the palatal canal and 30/06 in the buccal canal.

Figure 9

Photo of Gutta-percha cones.

Figure 10

Master cones in place: validation of working lengths and calibration of master cones, which are perfectly fitted with good resistance to withdrawal.

Figure 11

Smooth and controlled down-packing to avoid Gutta-percha extrusion beyond the apices using the down-pack handpiece of the Elements IC system. Successive wave compaction in the very open palatal canal to prevent any extrusion of canal obturation material.

Figures 12 and 13

Backfilling of the coronal two-thirds using the back-fill handpiece of the Elements IC system.

Figure 14

The canals were obturated by backfilling with the Elements IC system up to the access cavity.

Figures 15 and 16

Placement of Cavit at the base of the cavity to allow the colleague easy access if a prosthetic restoration is to be performed, followed by placement of Bulk composite, SimpliShade Bulk Fill Flow.

Figure 17

Verification of the obturation, which is dense and perfectly sealed at the apex in both buccal and palatal canals, with no overfilling.