Managing Anatomy

This patient presented with a symptomatic lower left central incisor #23. Both lower centrals were temporized with provisional crowns. The referring dentist was leaning towards extracting both teeth and replacing them with implants but the patient requested a second opinion from an endodontist (me!)

The pre-op X-ray showed two small teeth with short roots. Premature, dystrophic calcification was evident in both teeth with PAP present on the left central, which was also unresponsive to cold.

CBCT confirmed a periapical finding on #23 and also revealed a complex root canal anatomy in that tooth. Diagnosis was Symptomatic Apical Periodontitis and the recommended treatment plan was to keep both teeth and perform RCT on tooth #23.

Preserving tooth structure was critical to the treatment plan and it was decided to manage the case by treating the lingual canal conventionally followed by Radial Apical Cleansing of both canals with the laser-assisted protocol. The treatment was performed in a single visit and obdurated with bioceramic sealer and a single cone technique.

A post-op CBCT was taken to confirm that the complex root canal anatomy was well addressed.

The ability to manage complex anatomy with laser energy has been a game-changer and has changed the way we perceive, plan and perform endodontic therapy