#36 | Mandibular Molar Retreatment with Microscope (1/2)

#rootcanal #rootcanaltreatment #endodontics
49/F
The patient visited with a chief complaint of pain in a tooth that had previously undergone root canal treatment and crown placement. The diagnosis is as follows:
Dx)
Pulpal: Previously treated
Apical: Symptomatic apical periodontitis
Since the patient has been visiting our clinic for some time, I reviewed past panoramic X-rays. In 2019, the size of the periapical lesion was very small, but by 2021, it had significantly enlarged. Currently, there has been little change compared to 2021.
Considering that a tooth with prior root canal treatment rarely presents with acute symptoms, I initially suspected tooth #37, which showed a crack line. However, the patient was adamant that the pain was definitely from tooth #36. She also mentioned that for the past three days, the pain has been severe enough to require constant painkillers, making it difficult for her to lead a normal life, and she wished to proceed with treatment as soon as possible.
Access was made using TR-13C and a #4 round bur. The exposed GP was softened using a heat source and then removed with One Flare. While removing the distal GP, I felt a sensation of the GP being suddenly pulled out, at which point bleeding occurred. This made me suspect that this might be the cause of the patient’s pain. Subsequently, the working length was determined, and the usual canal shaping process was carried out. Since this was a retreatment, all canals were enlarged to size 30, and the MAF was determined using AJP (MB, ML - 30, D - 40).
After drying the canals, I noticed tissue lodged in the distolingual area. Additional space was created using One Flare. I also attempted to locate the MM canal and cleaned the isthmus between MB and ML with an ultrasonic device. After performing PUI and soaking with 6% NaOCl, I confirmed the connection between MB and ML during the canal drying process. Although slight bleeding was observed in the distal canal, it was not considered problematic. I explained the possibility of a flare-up to the patient and informed her that if no symptoms appeared, the root canal treatment would be completed at the next visit.
Passing on the knowledge. I'm combining the knowledge and the technique I have learnt from others, and I have not created anything on the video.

[@05719446]

출근해서 아침부터 뉴스 안보고 이거 보니 마음이 정화됩니다!

[@endoyoo]

좋은 말씀 감사드립니다!

[@hojunlee5319]

잘 봤습니다

[@endoyoo]

감사합니다

[@tkkim8793]

좋은영상 감사합니다!

[@endoyoo]

봐주셔서 감사합니다!

[@망고-z9c]

지피콘 제거하니 블리딩 뿜어나오는게 속시원하네요
통증의원인이 이거엿구나 하는 느낌이랄까,,

[@endoyoo]

저도 그 순간 '이것 때문에 아프셨구나' 싶었습니다.

[@DrShah_Dentist_in_Karad]

Such good direct vision. Can you show neck position. I keep head in lap position, with head slightly upwards for mandibular molars.

[@endoyoo]

I believe the EXTARO 300 provides a good field of view due to its wide focal range. The video linked below was recorded using the M320 microscope, but I think the patient's neck position is not significantly different from the position in the current video.
ruclips.net/video/MOu61OqGNiw/видео.htmlsi=GF3hhIyG3jB5toKJ