Case description
The initial x-ray photo of this symptomatic maxillary lateral incisor presented a large periapical lesion without visible borders, and in addition the canal morphology seemed to be dens-in-dente.
The immediate decision was to send the patient to a Cone-beam CT scan, in order to investigate the extent of the lesion, as well as to study the canal morphology in details.
The lesion seemed to almost penetrate the buccal cortical plate. The root canal morphology indeed turned out to be a dens-in-dente type 3 according to Ohlers classification. Variations of this morphology are demonstrated in the axial cross sections.
The main canal has a C-shape form in its coronal section, which turns into a circular canal around the dens in its middle part, and in the apical part the main canal and the canal of the dens converge into one common canal. The dens canal is round throughout its way, and in its coronal part it is also covered by enamel.
This analysis enabled Dr. Solomonov to choose the different instrumentation techniques: In the main canal he used the SAF System, due to its ability to accommodate to the irregular form, and in the dens canal he used standard NiTi rotary instruments.
The case was treated in two sessions, with calcium hydroxide medication in between. The obturation was performed by a combination technique.
The six-months follow-up x-rays (see in the photo gallery) reveal the asymptomatic healing process. The 2-years follow-up x-ray shows excellent healing.
About Dr. Michael Solomonov
Dr. Michael Solomonov, from Tel-Aviv, Israel, is the director of the endodontic specialty program at the Sheba medical center in Tel-HaShomer, Israel. He is a graduate of the Tel-Aviv University (1994) and of the endodontology specialty program at the Hebrew University Hadassah (2003). Besides teaching, Dr. Solomonov lectures around the world and operates a private clinic limited to endodontic treatment.
Contact details
Website: EndoCenter Israel
Phone: +972.3.529.3375
Email:
Address: 16 Bar-Kochva St., Bnei-Braq, Israel
