Pulp necrosis in tooth 45 with bifurcation in the middle third of the canal
Case report by Dr. Francisco de la Torre detailing pulp necrosis with acute apical periodontitis in tooth 45 with the particularity of a bifurcation in the middle third of the canal. He managed to successfully treat it thanks to proper diagnosis and the precurvature of the entire sequence of files used.
The patient was referred to the consultation of Dr. Francisco de la Torre in Vallodolid due to discomfort in tooth 45 when chewing.
After initial tests of negative sensitivity and pain on percussion, an X-ray was performed to extract conclusive results, and a possible widening of the ligament was observed. The diagnosis was pulp necrosis with acute apical periodontitis.
A bifurcation in the middle third was also suspected from the previous X-ray as the continuity of the canal is lost.
Diagnostic X-ray.
For this reason, the BlueShaper file system was selected to perform the canal treatment, since its absence of shape memory facilitates the pre-curving of the file and allows it to enter the bifurcations of the canals with ease.
Treatment
The sequence of BlueShaper files ended up being used in order to precurve and insert into each canal entrance in the bifurcation, and then be able to activate them. This is a great advantage for this type of anatomy because it allows work to be carried out on both root canals without much difficulty.
Once the working length was taken with the help of the apex locator integrated into the E-Connect S motor, the tip of the BlueShaper Z1 file was pre-curved to enter into one canal at a time. Next, the Z2, Z3 and Z4 files were used in sequence without brushing to avoid removing more dentin than necessary.
X-rays taken during clinical treatment.
Positive pressure irrigation was performed with an irrigation needle 27G and the final irrigation protocol was performed by activating the hypochlorite with the help of IrriSafe files.
Once instrumentation was performed and the final irrigation done, the obturation was completed with the Fast Pack Vertical Condensation System using continuous wave to fill the apical third and the Eighteeth Fast Fill device to fill the coronal third.
Image taken after 3D obturation.
Dr. Francisco de la Torre
Currently dedicated exclusively to endodontics, he completed his degree in Dentistry and specialized in Endodontics at Universidad Europea in Madrid. He then completed a Doctor of Dentistry degree, with a thesis on the connection between periapical lesions and diabetes. He is the author and co-author of numerous articles in reputable endodontic journals. Best clinical case award at the AEDE 2009 congress.
More information
A magnificent case by Francisco de la Torre who, thanks to the pre-curvature of the files, was able to successfully treat a bifurcation of the canal in the middle third.
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