Three canal mandibular second premolar #20 with a separated instrument.

Products: Pathfiles, Protaper Next

Tooth #20 diagnosed with previously initiated therapy with asymptomatic apical periodontitis. Patient with no relevant medical history. No Known Drug Allergies. Smoker. ASA II. Anaesthesia with 34mg 2% Lidocaine with 0.017mg 1:100,000 epinephrine IAN and Lingual block and 68mg 4% articaine with 0.017mg 1:100,000 epinephrine supplemental buccal infiltration. Single tooth dental dam isolation. Temporary filling and decay removed with round high speed bur. Access refined with ultrasonic tips. 3 canal orifices identified in the middle third of the root (Lingual, Disto-buccal and Mesio-Buccal). Separated instrument visible. Ultrasonic tip CPR used to vibrate the separated instrument. Three canal orifices identified. Manual glide path with 8k-10k. Patency achieved in all 3 canals. WL determination with EAL. Pathfiles 13-16-19 in all four canals to WL. All canals shaped with ProTaper Next X1 and X2 to WL. Canals irrigated with 5.25% Sodium hypochlorite and 17% EDTA. Obturation with gutta percha and AH plus sealer on a warm vertical condensation technique. PTFE and IRM placed as temporary filling. Post operative instructions given to the patient.

Name: Diogo Guerreiro

University: University of Michigan



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