Calcified Roots in 97-Year-Old’s #13

Summary

 

Calcified roots in a 97-year-old patient prove a unique challenge for a New York endodontist.

 

The Case

 

A 97-year-old-female presented with a chief complaint of extreme pain in the upper left quadrant.

 

A clinical exam revealed tooth #13 was extremely sensitive to percussion, negative to palpation, and non-responsive to both endo ice and electric pulp test. Radiograph revealed #13 had a calcified root canal system.

 

 

My diagnosis was necrotic pulp with symptomatic apical periodontitis.

 

The patient was extremely frail and had severe back pain. Due to the back pain, she was seated in a semi-upright position, with several cushions to help support her lower back. This presented its own unique challenges to work on a calcified tooth utilizing a dental microscope.

 

Shaping

 

Post-access, I used ProUltra Size 2 ultrasonic tips, as well as burs to trough and locate two canals. After locating the canals, they were negotiated with steel hand files using 17% EDTA and lubricant.

 

After obtaining a glide path with hand files, I used a WaveOne Gold Glider to maintain the glide path. The canals were instrumented using ProTaper Gold files, sizes S1, S2, and F1.

 

After experimenting with a lot of systems, I've found the ProTaper Gold files are by far the most efficient rotary files on the market right now, both in terms of ability to cut dentin and resistance to fracture.

 

At the first visit, after cleaning and shaping, the tooth was irrigated with a final irrigation of 17% EDTA activated with the EndoActivator. Calcium hydroxide paste was placed in both canals using a delivery tip and the Ca(OH)2 was activated using the EndoActivator. Blue teflon tape and a temporary filling material were used to seal the access. 

 

A Second Visit

 

Upon returning one month later, the patient was completely asymptomatic. The canals were irrigated with 5.25% hypochlorite during instrumentation. A ProTaper Gold F1 file was used to re-instrument the canal. A final irrigation was performed again with 17% EDTA and activated with the EndoActivator. A hydraulic condensation technique with sealer was used for obturation. Again, blue teflon tape and a temporary filling material were used to seal the access. 

 

 

In the radiograph you will notice post space, as requested by the referring dentist (the patient's general dentist). Patient was referred back for a final restoration.

 

All in all, this 97-year-old woman was an awesome patient and tolerated treatment extremely well!

 

About Dr. Craig Berry

 

Dr Craig Berry

 

Dr. Berry did both his undergraduate and postgraduate endodontic training at the University of Medicine and Dentistry of New Jersey. He became a board-certified endodontist shortly after finishing his residency in 2013. His practice, Long Island Endodontics, has two locations in both Woodmere and Merrick, NY.

 

He currently teaches part-time at the postgraduate program at the Lutheran Medical Center in Brooklyn, NY.

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