Why Extract Wizzies?
The case for saving tooth #48 (U.S. #32)
“Combining the severe curvature of the MB and DB canals with limited access made this a remarkable case to attempt.”
– Christopher Becir, D.D.S.
Cumberland, BC, Canada
Exam: Patient presented with pain in his lower right wisdom tooth. I/O exam showed MOBL decay into the nerve of tooth #48 (US #32). X-ray confirmed caries finding, as well as PARL around apex of mesial and distal root of 48 – consistent with symptoms of a chronic periapical abscess. Tooth #48 (US #32) was percussion positive but had absolutely no sensitivity to ice, heat or vitality testing.
Diagnosis: Pulpal Necrosis with Periapical Abscess
Technique: Access was obtained with the Endo Access Kit using the Tapered Diamond Bur and the Pulp Shaper Bur. After obtaining access, three canals were located: MB, DB and distal. NaOCl was placed in each canal and a sequence of Lexicon K-Files (#8, #10, #15) were used to establish a glide path. The estimated working lengths were 18 mm for the MB and DB canals, with distal canal being 17 mm. Working length was then confirmed in each canal using the ProMark Apex Locator.
Shaping was completed using ProTaper Gold Rotary Files. The coronal portion of each canal was pre-enlarged with the SX file. Each canal was then shaped successfully in sequence while irrigating with NaOCl. The MB and DB canals were finished with the F1 file to a size 20 with a .07 variable taper while the distal canal was finished with the F3 file to a size 30 with a .09 variable taper. Following shaping, QMix 2in1 Irrigating Solution was used as a final rinse in each canal and was activated with the EndoActivator for 60 seconds. Paper points were then used to dry the canals and sealer was mixed and placed in each canal until completely dry.
Each canal was obturated with the corresponding GuttaCore Crosslinked Gutta-Percha Core Obturator: Yellow (20/.07) in the MB and DB canals and Blue (30/.09) in the distal. Following obturation, the excess gutta-percha was trimmed and a composite filling was placed.
“Managing a curved canal is always a challenging, but rewarding experience. Combining the severe curvature of the MB and DB canals with the limited access made this a remarkable case to attempt. However, I felt confident that with the flexibility of the ProTaper Gold files, along with the flowable characteristics of GuttaCore, that I would be able to achieve an excellent outcome. The result speaks for itself.”
Dr. Christopher Becir earned his Bachelor of Science degree at the University of British Columbia before going on to study dentistry at the University of Western Ontario, where he graduated with distinction receiving his Doctorate of Dental Surgery. He currently practices full-time at the Cumberland Dental Centre in Cumberland, British Columbia.