Filling of lateral canals and additional portals of exit is required for endodontic success. A prerequisite, however, is well shaped canals (tapered NiTi preps) and well cleaned canals (irrigant activation).
The following cases demonstrate hydraulic obturation well.
This UL7 with deep caries has no mysterious anatomy on the pre-treatment radiograph. Following caries removal, GIC build-up and ortho-band stabilisation; four canals were cleaned and shaped before filling with System B and thermoplastic backfilling with an Obtura gun.
The Final radiograph shows complex anatomy with apical anastomoses between canals. A Nayyar core has been placed for the referring dentist to prepare for a crown
The pre-treatment radiograph of this UL2 with a large apical radiolucency hints at some “unusual” anatomy in the apical zone.
The follow-up radiograph taken six months later shows good healing due to cleaning and obturation of apical delta anatomy using System B.
The small radiopacities are remnants of AH Plus, a very opaque and insoluble resin sealer with many advantages over calcium based sealers.
There is seldom an indication for surgical treatment, even with cyst-like lesions as demonstrated in the following case.
The pre-treatment radiograph shows large lesions on these upper centrals with open apices, due to trauma at a young age. After cleaning, obturation was performed with MTA apical plugs and thermoplastic backfilling. The follow-up radiograph was taken at just 9 months and shows bony healing in progress. The artefact in the top left hand corner is a nose ring.
The pre-treatment radiograph shows very large lesions on this Lower 6, it also had with a draining sinus.
Management included long term dressing with an iodoform paste. Healing of these lesions is demonstrated after only three months when the next radiograph was taken at completion of the treatment.
A Lateral canal has been filled in coronal half of the mesial root system.
Here a large lesion is associated with missed anatomy and a leaking silver point. The crown was removed and the tooth re-treated.
A Nayyar core and temporary crown were placed. Healing was demonstrated at 9 months so that the referring dentist could confidently place a new crown.
The initial radiograph was taken on completion of the treatment and shows a great deal of bone loss on the lateral aspect of the UL1.
Almost full resolution is seen between UL1 and UL2 at the 12 month follow-up.
Post removal, re-treatment and healing at 12 month follow-up.
A referring dentist separated an instrument deep in this upper premolar. After removing it and completing RCT a Nayyar core was placed so the referring dentist could easily prepare a crown.
Obliterated canals are notoriously difficult to locate, even with a microscope. Here a referring dentist could not locate the canal in this UL1 and rightly referred the case to Henk before perforating.
Henk located the canal and completed treatment using ISO files so as not to weaken the tooth further.