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Being as Schilder as possible

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Dr. Oscar Navarrete's picture
Joined: 29 Sep 2015

Pacient: Female, 72

Tooth # 47

Dx. Symptomatic irreversible pulpitis/Symptomatic apical periodontitis, deep caries.

Tx: Initialy, root canal treatment and crown reconstruction with endoposts.

Good prognosis.

This lady is affected of Wallenberg’s syndrome as consequence of a stroke; her worst symptom is that she’s strained with very heavy dizziness. So we planned to make the treatment in 2 appointments.

First appointment: Full instrumentation, irrigation protocol and CaOH intracanals.

Second appointment: She presented with the distal aspect of the crown fractured below the gum level, so a crown lengthening was needed in order to isolate properly, again, irrigation protocol and CaOH intracanals.

A third appointment was needed to complete the procedures.

Instrumentation: When beginning the cleaning and shaping process especially of the distal canal many numerous catches were encountered with the precurved hand K-files. The coronal flaring was widened to a degree consistent with the root form for each root and numerous recapitulations were employed. Cone fitting was a much laboured process but eventually smooth tug-back was gained in each canal and obturation was completed uneventfully. The specific characteristics of the distal root were challenging, which required gradual apical preparation enlargement of a few millimeters back from the working length. Minimal rotary file use was employed as numerous pre curved hand file recapitulations eventually smoothed out the fins, branches, and loops so that placement of a precut gutta percha cone could finally be placed securely with adequate width for sealing. So:

K.02 #10 to #25 + GG’s 3, 2 and 1 + GT.12/70 + modified Protapers Sx and S1 (tips clipped 4mm and burnished 1mm) -avoiding engagement-, + normal S1 to WL. + K.02 in crown down fashion for capture zone and calibration with manual Protapers.

Irrigation: Manual agitation, sonic and PUI with NaOcl 5.2%, EDTA, H2O2 and ethylic alcohol 90% 

Obturation: Warm vertical condensation with gutapercha and AH Plus.

Crown reconstruction: Supporting glass fiber post: Fibio by Anthogyr. Balance nylon posts: custom made tips from discarded Microbrushes.

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