Complex roots with difficult access

1 visit lateral incisior Coagulum over implant Trauma- Endo-Surgery Pre bent SS hand files Isolation for post buildup Placing MTA retrofill Horizontal percussion Calcified central incisor Temporary glass ionomer Irreversible pulpitis Ortho and retrograde coronal restoration Cervical hypersensitivity	23 year recall A gone case Weird lesion Huge lesion Pulpitis on 45 Isthmus anatomy 14 year recall Caries exposure Tooth #37 Perio inflammation Severe percussion 2 D healing Crown access	Canal with acute bend Cracked tooth syndrome Tooth discolorisation Mesial systems with POE Endo treatment Newsletter 30th May 2010 Endo implant To CT or not Buccal gingival swelling Polished collar Molar restoration Immediate implant Whiteline puzzle	Final coronal preparation Type 3 Heithersay resorption 19 year recall - Molar case Isthmus Anatomy Acute irrversible pulpitis Horizonatal,vertical percussion Orthoband cases Symmetric resorption Removing Niti instruments Calcified incisor Ca(OH)2 extrusion Resorption defect Apico on MTA

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Complex roots with difficult access - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are - www.rxroots.com

From: Terry Pannkuk
To: ROOTS
Sent: Wednesday, June 23, 2010 11:18 AM
Subject: [roots] Super-long curved, complex roots with difficult access-CBCT

This patient was very difficult to treat; just finished him a few minutes ago.  The CBCT was helpful just so I could
validate what I did at the end and make sure I didn’t miss any major systems (I didn’t’ charge because it was mainly
for my personal interest). There wasn’t really a separate MB2 orifice but I felt some action apically as I went
through numerous recapitulations with precurved K-files.    Same with the palatal.  My EAL estimate was 2mm short
(as usual I trusted the RT more.good thing).  The MB had an apical trifurcation which can be seen on the transverse
sections.  It also had a prominent furcation accessory at midroot. Wild case, good demo CT, almost cone-cut the
palatal root on the CT.  The patient was very tall -  Terry

Hmmm, the thickening of the sinus membrane adjacent to the palatal root looks suspiciously familiar.
Was this a necrotic tooth?  Please make a note to CBCT this tooth again in 6 months to assess the change (or not)
of the sinus post-RCT. - michael p

LOL....it was necrotic and this was the second visit.

The palatal root was 28 mm long, DB 26mm and the MB short branch 23.5mm and the MB long branch 25.5mm.
The CBCT simply showed what I did and did not help me do it; hence the free charge.  There was no COD with the CBCT
for this case -  Terry

Protaper flaring 6 yr old Empress Cvek pulpotomy Middle mesial Endo misdiagnosis MTA retrofill Resin core BW importance Bicuspid tooth Necrotic #8 treatment Finding MB2 / MB3 Deep in a canal Broken file retrieval Molar cases Pushed over apex MB2 and palatal canal Long lower third Veneer cases CT Implant surgury	Weird Anatomy Apical trifurcation Canal and Ultrasonics Cotton stuffed chamber Pulp floor sandblasting Silver point removal Difficult acute curve Marked swelling 5 canaled premolar Sealer overextension Complex anatomy Secondary caries Zygomatic arch Confluent mesials LL 1st molar (#19) Shaping vs Cleaning First bicuspid In Vivo mesial view Inaccesible canals	Premolar 45 Ortho and implant Radioluscency Lateral incisor Obturation Churning irrigant Cold lateral Tipped to lingual Acute pulpitis images Middle distal canal Silver point Crown preparation Epiphany healing Weird anatomy Dual Xenon Looking for MB2 Upper molar resorption Acute apical abcess Finding MB2	Gingival inflammation Irreversible pulpitis AG BU ortho band TF Files using TF files Broken bur Warm technique Restorative prognosis Tooth # 20 and #30 Apical third 3 canal premolar Severe curvature Interesting anatomy Chamber floor Zirconia crown Dycal matrix Cracked tooth Tooth structure loss Multiplanar curves