Three’s a Crowd | #23, #24, #25

Products: Vortex Blue (15.04, 25.04, 35.04), ProTaper SX, X-Smart Motor, Ready Steel Hand Files

This fun case involved the use of CBCT access guidance and a lot of crown down filing! The patient’s chief complaint was: “There’s a bump on my lower gums.” Pre op examination revealed a draining sinus tract stoma associated with the apex of #23. Radiographs revealed periapical radiolucencies associated with #23, 24, and 25, as well as moderately calcified canals. Pre op diagnoses were as follows:
#23 – Necrotic pulp, Chronic Apical Abscess
#24 – Necrotic pulp, Symptomatic Apical Periodontitis
#25 – Necrotic pulp, Asymptomatic Apical Periodontitis

The plan, then, was to complete NSRCT on #23, 24, 25. However, my patient had skeletomuscular issues that prevented them from laying back more than a few degrees. This meant that I would have to work while standing, from about a 7 o’clock position, as my patient sat nearly upright. A pre-op CBCT revealed that each tooth of concern only had the 1 canal. Using CBCT guidance, I was able to plan an incisal accesses on all 3 teeth.

I decided to complete the treatment in 2 visits, working on all 3 teeth at the same time, from the 7 o’clock position. I can confidently say that I was in more pain than my patient from this appointment! After incisal accesses were all successfully completed and my first hand file was brought to length, I opened up the orifices with my ProTaper SX rotaries, and then relied on my Vortex Blue rotaries to get me down these tight canals. After the first visit, the sinus tract stoma had healed and the patient was asymptomatic. At the second visit, I completed the root canal treatments with matching Vortex Gutta Percha, and I completed the incisal composite restorations as well. The patient was referred back to their general dentist and left satisfied. And, eventually, the soreness in my back and shoulders went away too!

Name: Erik Balinghasay

University:  University of Washington

Pre-Op Radiograph

Post-Op Radiograph

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