Vortex Blue Vs. Deep Apical Split (Clinical Case)

The Case

The patient’s chief complaint was "dull, constant pain" on tooth #13 following caries removal by the referring dentist. Symptoms were aggravated by biting and percussion.

Probings were normal. Radiographic examination revealed a deep apical split of the canals about 4mm from the apex, with unremarkable PDL space. The patient presented with a diagnosis of pulp necrosis with symptomatic apical periodontitis.

Shaping

I used Vortex Blue files for shaping. In this case, the files had no issue with flexibility, and they maintained a high cutting efficiency.

Post-access, I located only one canal – the one I had identified in the radiograph that split into two apical canals about 4mm from the apex.

Initial canal exploration was unimpeded until about 16mm from my reference point. A 10-K file was pre-bent to negotiate the apical segments. Crown down was used up to a 25.06 Vortex Blue file to the level of the split, with gentle lateral brushing on the outstroke, and the apical segments were further enlarged with pre-bent hand files. The case was finished with a 30.04 Vortex Blue file.

Irrigation and Obturation

For irrigation, I used 5% NaOCl and 17% EDTA solution with passive ultrasonic irrigation. Prior to obturation, I sealed using a eugenol-based sealer.

One of the apical canals was blocked with a flexible NiTi plugger, while the other canal was obturated and downpacked with warm vertical condensation to the level of the split. The plugger was removed, and the second canal was also obturated in a similar fashion. Calamus was used for the backfill.

Restoration

Glass ionomer was used for temporization, and a post, core and crown were advised for definitive restoration.


About Dr. Dan Tran

Dr. Dan TranDr. Dan Tran received his DDS from the University of the Pacific. He attended a General Practice Residency at Albert Einstein Medical Center. He then practiced general dentistry for two years, and he is currently finishing up his endodontics residency at the University of California San Francisco. He plans to practice in the Bay Area.

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