Micro-Endodontic surgery with 3D retro-cleaning

A 46-year-old male patient was presented at our clinic with pain associated with the right maxillary area. Upon 2D periapical radiographic examination, a previous root canal treatment of 1.5 was observed. The obturation was shorter than the root apex. The canal’s area apical to the short obturation could not be visualized, almost certainly because it was calcified. The diagnosis was symptomatic apical periodontitis caused by an improper root canal treatment. Consequently, a 3D Cone-beam computed tomography (CBCT) was performed (small fov and high resolution 75 microns) to analyze the apical third of tooth1.5. Examining the CBCT, it was not possible to detect the root canal. The treatment of choice was endodontic surgery. This choice was justified by the difficulty of finding the root canal, even when using the high-resolution 3D CBCT, which means that the canal was completely calcified. Moreover, it can be very difficult or even impossible to perform an orthograde root canal treatment when the calcification is present in the apical third, and the root length is relatively long. It was impossible to locate the root canal during the apicoectomy procedure under high magnification (x24). However, with the operative microscope’s aid, a white circular area in the middle of the root was detected, indicating the calcified canal. Following that, the calcification was removed using an ultrasonic tip (P 14D, Satelec), and the treatment was performed.

In this case, 3D retro-cleaning was performed (the first irrigant activation technique applied in Endodontic Surgery) and the apical cut was reduced. One year, it was possible to observe adequate healing.

Figure 1
Preoperative CBCT of tooth 1.5 showing the calcification in the apical third. The root canal was not visible.

 

Figure 2
After apicoectomy using a micro-mirror and operative microscope, it is possible to see the calcified white area in the middle of the root. When the calcification was visualized under magnification, it was removed using a retro tip used to perform the retro preparation. Then a 3D retro-cleaning was performed.
Figure 3
Retro Obturation.
Figure 4
Follow up at 8 months showing healing.