Root Canal System

1
Root Canal System
The complexity of the root canal system cannot be
underestimated. All portals of exit must be
sealed to ensure elimination of peri-radicular
pathology
2
Reengineering

• Flexipost cemented in palatal canal removed
  with ultrasonic tip
• MB2 orifice not identified during previous
  procedure
• contaminants evident in all canals

3
Reengineering

• post removed all canals identified and
  negotiated
• Class I inlay preparation initiated for NiTi file
  accessibility and straight line access
• heated NaOCl (150o F) and EDTA left to soak in
  chamber and canal system throughout procedure

4
Reengineering

• canals shaped, cleaned and obturated
• gutta-percha sealing to level of orifice
  interface with chamber floor
• bristle brush and ethanol used to remove sealer
  from chamber
• chamber then etched with phosphoric acid in
  preparation for sealing of the chamber floor and
  canal orifices

5
Reengineering

• dentinal adhesive (PQ1) used in conjunction with
  Permaflo to create bonded composite layer over
  the canal entrances to the root canal system as
  well as close any furcal canals
• further layering of core material can be applied
  after micro-etching chamber surface
• bonded core depth is sufficient to preclude need
  for post placement

6
Reengineering

• fracture of the mesial-buccal root became
  apparent on resection common with amalgam
  retrogrades not placed with ultrasonics
• distal-buccal apex was weakened by original
  retro-preparation and resection to stable surface
  shortened root and precluded predictability of
  trisection

7
Reengineering

• The unexpected loss of the tooth is unfortunate
  for the patient, however, it does demonstrate how
  the biologic imperative is the foundation for all
  we do.