From: Rafaël Michiels
To: ROOTS
Sent: Monday, December 20, 2010 6:08 AM
Subject: [roots] Woodpecker Case

Here is case in which I used the pecking with the Profile 15.04, I thougth I'd call it woodpecker technique,
because it sounds catchy.

Anyway, critique and comments are welcome as always and more cases will follow within a day or 10 again - Rafaël

Treating a heavily calcified molar with the woodpecker technique

Diagnosis

Tooth #3 was referred because it showed a chronic apical abcess which drained through a
sinus tract.
After putting a gutta percha cone in the sinus tract, I was not sure wether it was really only
tooth #3 was involved. Maybe tooth #2 was also involved.
Tooth #2 was vaguely responsive to cold and non-responsive to EPT.



Treatment

I decided to 2-step tooth #3 and see if the sinus tract would resolve in between the two
visits. If it did not resolve, I would also drill a test cavity in tooth #2.
After removal of the temporary filling, I came across a completely obliterated root canal
system. It took me about 2 hours to get a size 25 file in the palatal and disto-buccal to
working length. Initially it was impossible to get to working length with handfiles, so I used
about 10 Profiles 15.04 in a pecking motion to get to working length. A lot of pecking,
lubricating and checking of the files and working length.

Eventually I had prepared the palatal and disto-buccal canal at the end of the first visit.
I placed calciumhydroxide, a cotton pellet and a temporary filling in glass ionomer.



After the first visit the sinus tract resolved and I started to prep the mesio-buccal canal. A
second mesio-buccal canal was found, but after throughing with the US, it became evident
that it joined the first mesio-buccal canal in the coronal part. I took me another hour to
peck to working length in the mesio-buccal canal. Finally after 3 hours in total I had


reached working length in all three roots and got patency too. The root canals were
eventually obturated with guttapercha according to the classic warm vertical condensation
technique. MAF were 35.06 in P and DB canals and 30.06 in the MB canal. I used Topseal
as sealer. Irrigation was performed with 5% NaOCl and 10% CA, both activated with the
US.
Further follow-up is needed, also for tooth #2. And tooth #4 needs to get the filling
replaced. The little overfill from the temporary filling mesially was afterwards removed with
a scaler.
Too bad that I am not able to take clinical pictures in the practice were this treatment was
performed.
Total working time: 4h
Prognosis: good