A case study by Dr. Chafic Safi, Centre Endodontique St-Laurent
A 39 year-old caucasian female presented to our office with a chief complaint:
“I have a root canal to be completed, there is something that never heals on my gums.”
Analysis
Clinical exam revealed that tooth #16 has a temporary restoration with a sinus tract. Radiological exam revealed a previously accessed tooth with a periapical radiolucency around the mesio-buccal root and a traceable sinus tract.
The patient was asymptomatic at time of consultation.
Diagnosis
The diagnosis was: previously initiated therapy and chronic apical abscess.
Treatment
The treatment options offered to the patient were:
- Root canal treatment. Prognosis: Favorable
- Extraction. Prognosis: Favorable
Treatment Selection
The patient consented for root canal treatment.
The Treatment
The procedure was completed in 2 visits with placement of Calcium Hydroxide as intra-canal medicament. The sinus tract had resolved by the second visit. The final irrigation protocol for both visits consisted of the following: 6% NaOCl followed by 17% EDTA which was then followed by 2% Chlorhexidine.
It is well known that the prevalence of second Mesio-Buccal canals (MB2) in an upper molar is more than 90%. This case however not only had an MB2 but also an MB3, a third Mesio-Buccal canal.
Without proper magnification and illumination via a dental operating microscope, finding this MB3 would not have been possible!
All 5 canals, Palatal, Disto-Buccal, MB1, MB2, and MB3 were instrumented using the XP-3D Shaper file and obturated using cold hydraulic condensation with Bioceramic Sealer.
Follow-up
The post-operative radiograph shows that all 3 mesio-buccal canals join into one large canal.
More information
Advantages of Bioceramic Sealer:
- Biocompatible
- Hydrophilic
- Binds to dentin
- Bioactive/ induces stem cell differentiation
- Does not shrink
- Does not wash out
