Split Distal Canal #18

“GuttaCore provided an excellent 3D obturation, moving easily around the curves and spreading gutta-percha and sealer along the accessory canals.”

Diego Andrade, DDS
Jacksonville, FL

Description of the tooth: The patient reported pain in tooth #18. Radiographic examination revealed occlusal radiolucency, suggesting gross decay close to the pulp horns. The tooth had mesial curved canals. Upon clinical examination, the tooth was positive to percussion and cold tests with pain lingering; the tooth also had no mobility when probing within normal limits.

Diagnosis: Symptomatic irreversible pulpitis and symptomatic apical periodontitis. Endodontic treatment was recommended.

Technique: Following caries removal, endodontic access was achieved. Under microscope, no evidence of fracture or cracks was noted. Four canals were found (MB, ML, DB and DL). An initial glide path was created with Lexicon stainless steel hand files, and working lengths were established using the ProMark apex locator. All canals were 22 mm long.

The glide path was enlarged incrementally with ProGlider rotary glide path files and canals were cleaned and shaped with WaveOne reciprocating files, size .08/25 (Primary). A size verifier was introduced at all canals to verify the right shape. The canals were irrigated with NaOCl 6%, saline and QMix 2in1 irrigating solution, all of which were activated with the EndoActivator, allowing the penetration of disinfectants to the working length and into accessory canals. All canals were filled with GuttaCore crosslinked gutta-percha core obturators, size 25, and ThermaSeal Plus Ribbon sealer.

It was challenging to add two GuttaCore carriers in the distal canals since there was only one entrance which split into two canals at the mid-third of the root. In order to fill the two distal canals, a WaveOne paper point was placed in one canal while the other was being filled.

“GuttaCore provided an excellent 3D obturation, moving easily around the curves and spreading gutta-percha and sealer along the accessory canals.”

Dr. Diego Andrade graduated dental school from São Paulo State University – Brazil in 2005 and then went to work as a missionary providing dental care for underserved people in more than 24 countries. He was accepted into a one year fellowship in endodontics at the University of Florida – Gainesville prior to attending Columbia University College of Dental Medicine’s endodontics program, where he graduated in 2014.

Dr. Andrade has been active in dental associations in the U.S. and internationally. He is a member of the American Association of Endodontists and International Association of Dental Research. He has published articles on topics associated with endodontics, lasers and whitening. He has lectured nationally and internationally and has also presented his research at numerous conferences.

Dr. Andrade has received several awards, including one from the American Association of Endodontists at the national meeting in Hawaii 2013. He is currently practicing endodontics in a private practice in Jacksonville, FL, and teaching part-time at Columbia University.


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