ProTaper Gold and GuttaCore Work in Concert on #26 FDI
A straightforward-looking #26 FDI (#14 US) turns out to be a gorgeous 2-2-1 configuration MB root and a soft S-shaped MB2. Fireworks at the end of the distal!
Chief Complaints: The patient felt pain with #26 FDI (#14 US) on biting. Food kept getting stuck between #25 / #26 FDI (#13 / #14 US) as well.
Radiograph: My exam of the patient revealed large DOB caries with #25. On #26, I found MO caries and periapical radiolucency on the distal root. A large, broken and leaky filling existed on the DOBL of #26.
Diagnosis: My diagnosis was caries on #25 and pulp necrosis with symptomatic apical periodontitis on #26.
Access: For access, I removed all the old decay and filling, then placed in a brand new one.
Shaping: Once the orifice was opened with Sx, straight line access was achieved. I located 4 canals. MB2 was very thin, and I found the apex difficult to reach. I used several 06/08 hand files to reach length and establish patency. Once the ProGlider went to length, the rest of the files were a breeze. ProTaper Gold exhibited excellent flexibility with minimal transportation. I used ProTaper Gold up to F1 in MB 1 / 2. Then I used F2 with the palatal. I finished apical preparation after apical gauging to 30-04 with Vortex Blue with MB and DB and 35-04 with the palatal.
Irrigation: For irrigation, I alternated full strength, warm NaOCl and EDTA with the EndoActivator.
Sealer and Obturation: I sealed using Ribbon ThermaSeal Plus, and I used GuttaCore to obturate. Even with lateral canals, it's easy to achieve a 3D fill when you use GuttaCore. I prefer using warm, thermoplastic gutta-percha as my obturation material of choice.
Post-Op Plan: I managed to place an IRM for 2 weeks. The patient returned for post-op restoration with composite resin, and I advised an FGC.
Dr. Rahul Shah is a 2010 BDS graduate from Mumbai. He pursued a DDS and graduated with distinction and multiple awards from the University of Western Ontario, London, Canada. After graduation in 2015, he was selected to complete a multi-disciplinary hospital residency at the Mount Sinai Hospital through the University of Toronto. This residency provided him with advanced training in all the specialties of dentistry including oral surgery, treatment of medically complex patients and treatment of people with disabilities.
Dr. Shah is an active member of the American Academy of Cosmetic Dentistry, Academy of General Dentistry, Canadian Dental Association, American Academy of Implant Dentistry and the Ontario Dental Association. He is a firm believer in lifelong learning. He is also passionate about giving back and delivering care to his community, both at home and abroad. Dr. Shah currently holds the position of Adjunct Clinical Instructor in the Endodontics department at Western University and works full-time through two practices in the GTA. You can follow his cases on Instagram: @yourgtadentist.
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