Severe Mid and Apical Curves
Roots have Curvatures, Calcifications & Lesions
Clinician: Viraj Vora, DDS, MS, Vaughan, ON, Canada
Description of tooth: Maxillary first molar #14. 65 year-old healthy female. Previous history of pain to chewing in the upper right quadrant. Clinically, there was no response to thermal testing on the tooth. Radiographically, the tooth showed accentuated mid and apical curvatures in the buccal roots [Fig 1]. Coronal calcifications and periapical lesions were present around the mesial and palatal roots.
Diagnosis: Necrosis with symptomatic apical periodontitis.
Technique: 72mg Lidocaine 2% with 0.036mg epinephrine was administered via buccal and palatal infiltration. Rubber dam placement and access was created into the pulp chamber with four orifices being located, MB1, MB2, DB and P. Access refinement was completed using ProUltra #2 tip.
The exploration of all systems was completed with 06-20 Lexicon K-files using a step-back technique and copious irrigation of 6.15% sodium hypochlorite and alternate 17%aq EDTA. Coronal enlargement of all canals was achieved by using ProTaper Universal SX. Working length was established in all buccal canals with #15 Lexicon K-file and in palatal canal with a #20 Lexicon K-file. The working length was confirmed using Root ZX apex locator.
Patency was confirmed in all canal systems with a #10 Lexicon K-file. Glide path refined to length in buccal canals using #15/.04 Vortex followed by #20/.06 Vortex to length. Glide path refined in the palatal canal using 30/.06 Vortex to length. All buccal canals were subsequently finished to 25/.04 Vortex and palatal to 35/.04 Vortex.
Radiographic working length was confirmed with conefit radiograph using Vortex .04 taper ISO cones [Fig 2] Obturation was completed using the warm vertical compaction method [Fig 3].
Dr. Viraj Vora graduated with a dental degree (DDS) from the University of Western Ontario in 2005. He practiced general dentistry for three years and then entered the University of Michigan in 2008 where he earned a Master of Science (MS) and a certificate of specialty in Endodontics.
During his time at the University of Michigan, Dr. Vora conducted a comprehensive analysis of the endodontic literature over the last 70 years for his masters research thesis. His work was awarded first prize at the annual Michigan Research Meeting as well as two awards from the Rackham School of Graduate Studies. He also had the opportunity to present his research at the American Association of Dental Research (AADR) meeting in Washington 2010. Dr. Vora is also a Fellow of the Royal College of Dentists of Canada for the specialty of Endodontics and a Diplomate of the American Board of Endodontics.
Returning to Canada, Dr. Vora practiced Endodontics in London, Ontario for two years before moving to Vaughan in March 2013 to set up his own private practice.
Dr. Vora has a part-time faculty position at the University of Western Ontario undergraduate Endodontics program. He is also part of the scientific advisory committee for the Journal of Endodontics. Dr. Vora’s specific interest in endodontics includes root canal anatomy, outcomes research and materials science.