Memoir~clinical cases

 The objective of apical surgery is to surgically maintain a tooth that has an endodontic lesion which cannot be resolved by conventional endodontic (re-)treatment (von Arx 2005). The evaluation of a case referred for apical surgery must always include a careful weighing of the advantages and disadvantages of surgical and non-surgical intervention, i.e., the possibility of a conventional root-canal (re-) treatment should be considered as a therapeutic option In the present case surgery was done on lower anterior teeth.  Tissue reflection should begin from the vertical releasing incision at the junction of the submucosa and the attached gingiva. After the tissue is reflected, it must be retracted to provide adequate access for bone removal and root-end procedures. Removal of cortical bone to expose the root apex. currettage os done to remove cyst and lining.   The root has a darker, yellowish color and is hard, whereas the bone is white, soft, and bleeds when scrapped...

  Man dibular first molars are the first posterior teeth to erupt in permanent dentition and are those that most often suffer from caries. They are also the teeth that exhibit considerable anatomical variation and abnormalities regarding the number of roots and root canals. Therefore the clinician should know the various morphologic aberrations occurring in this tooth before starting the treatment. This case presents with mandibular first molars with 3 distal root canals and one root. The tooth was treated endodontically with the help of dental operating microscope. CASE 1: Local anaesthesia was induced using 1.8 ml of 2% Lignocaine and Adrenaline (Xylocaine; AstraZeneca Pharma Ind Ltd, Bangalore, India). The tooth was isolated using rubber dam and an endodontic access opening was established. The orifices of mesiobuccal, mesiolingual, distobuccal and distolingual were apparent and were initially located. The floor of the pulp chamber was viewed under dental operating microscope (...

  In our clinical practise, we often assume a canine to have one root and one root canal. So was my assumption but my habit of critically evaluating the preoperative radiograph has helped to predict the presence of 2 root canals in the present case. On a literature search, I have realised that the occurrence of 2 canals is as high as 12% in some populations and it was about 3.2% in the Indian population. This made me realise how often we might be missing out on these extra canals which might later cause treatment failure.  On examining the preoperative radiograph 2 root canals were seen joining at the apex. It shows a typical Vertucci type II canal system. we went ahead with access opening which was made in a buccolingual direction similar to maxillary premolar. the simple logic here is that the canine roots are broader on the buccolingual direction and that facilitates extra canals. The canals were slowly negotiated with a 10 size K file and working length was determined and ...