Root canal treatment on the complex case using ultrasonics: a case report

• Main Authors: Wibowo, L.H., Elline, E., Fibryanto, E., Prahasti, A.E., Zulkifly, Dinie Qurratuaini
• Format: Book Chapter
• Language: English
• Published: CRC Press 2024
• Subjects: RK Dentistry
• Online Access: http://irep.iium.edu.my/111207/2/111207_Root%20canal%20treatment%20on%20the%20complex%20case.pdf; http://irep.iium.edu.my/111207/; https://www.taylorfrancis.com/books/edit/10.1201/9781003402374/quality-improvement-dental-medical-knowledge-research-skills-ethics-facing-global-challenges-armelia-sari-widyarman-muhammad-ihsan-rizal-moehammad-orliando-roeslan-carolina-damayanti-marpaung; https://doi.org/10.1201/9781003402374

This is a complex case involving the management of a tooth with pulp stone and an S-shaped canal configuration. The pulp stone is a type of pulp calcification with prevalence of up to 50%. They can be found in either coronal, radicular, or both pulpal regions: and their presence may cause difficulty during access cavity. S-shaped canals may involve several curvatures, with maximal curvature in the apical third. These double-curved canals are usually identified radiographically in a mesiodistal direction. Mostly, S-shaped canals are found in maxillary lateral incisors, canines and premolars, and mandibular molars. A 27-year-old female presented with spontaneous pain for approximately two months. Clinical examination showed leaking existing temporary restorations on teeth #11 and #12. The radiographic examination showed that teeth #11 and #12 had fractures involving the pulp, with an S-shaped canal configuration on tooth 12 and pulp stones on tooth #11. The diagnoses for both teeth were irreversible pulpitis. Following the access cavity on tooth #11, the pulp stone was removed using ET8D ultrasonic tip. Meanwhile, for tooth #12, an S-shaped canal was encountered at the apical third, and stripping occurred at the inner curvature confirmed on the radiograph. Single-visit endodontic treatment was performed prior to direct composite restoration. Removal of pulp stone poses a challenge to the clinician during access cavity, while thorough cleaning and shaping of an S-shaped canal require high operator skill. A proper armamentarium as well as the usage of magnification is of paramount importance to avoid iatrogenic damages such as stripping/ledging of the root canal system.