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Missed anatomy via falsa and apical perforation (by Ilya Mer)

All clinical cases Cases by Ilya Mer Endodontics Middle mesial Perforation repair Retreatment Unusual anatomyPublished May 20, 2012 at 8:02 am 1 Comment

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Patient have had a toothache and after he was examinated by his dentist got recommendation to make RCT of tooth #36. By some reason he had held the decision making over until the severe pain come and that time extirpation has been made by another dentist. Nonetheless the treatment the patient was still in pain and the dentist spent more than 2 additional appointments to complete the treatment. The situation came down but tooth was still sensitive. A month after a revision was attempted, and calcium hydroxide was placed insight but patient had only temporarily relief. At that point the patient was referred to my office

Preoperative X-rays, root canal system temporary dressed with Ca(OH)2

After temporary filling and calcium hydroxide dressing were removed I tried to understand what was the problem of the tooth and placed files and made an X-ray. The mesio-lingual looked correct (white arrow) but not mesio-buccal that probably was transported in the apical third (red arrow)

Actually that was the problem and true mesio-buccal canal orifice was located on the internal-distal surface of the root and was explored and found with Micro-opener. It had merged with lingual canal (red arrows) in the apical third, an additional middle mesial canal was found (orange arrows) it also merged into the big mesial canal system. Via falsa had ended in a small perforation and was obturated the same as a canal, means gutta-percha and sealer

Final X-rays

 

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