Case Study 2

Case Study 2

Case study from a colleague
I had this walk in emergency today
A large palatal swelling which I incised and then I opened up the tooth and got some drainage from the palatal canal
I’ve found and instrumented the mb1, mb2 and p
I can’t drop into the dB canal, not even the slightest of catch
I took the dam off to orientate myself, I should be directly over the canal. I’ve tried troughing with an ultrasonic but no joy
Any tips??
Questions and Comments
  • Use the mb2 as reference to locate DB (have a look on a photo I posted sometime ago) or using the developmental lines. I can see it there, so it should be fairly easy to locate. Also use a small LN bur to remove restrictive dentine, if you still cannot… 
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  • I had a similar case with a very unusual PC, but I was searching for the MB1. I placed a dot of warm GP on the spot I thought the orifice would be, removed the RD not to have the clamp superimposed, a bit of cotton and Cavit and XRay. I found it 2 minutes later.
    May be an image of x-ray
  • Stewart Cochrane
    Green caries marker can sometimes help too.
  • Mitul Patel
    All of the above suggestions should work. Once I used caries detector dye to stain the canal as a long shot and it worked
  • Adrian P Jones
    What is your level of magnification? Drill any deeper and you will perforate. The opening may be closer to the mb orifice than usual. You can sometimes locate the orifice using a bubble test after using hypochlorite on the floor of the pulp chamber, i… 
    • Admin
      Adrian. Absolutely. Being able to recognise colour changes and the meaning is fundamental to finding canals
  • Ammar Al- Hourani
    Very good tips. A big one for me is the Endotracer, LN burs, look at where the debris settles, that sometimes shows u the opening of the canal. Moreover, the DB can sometimes be more central on the pulp floor.
    Another good tip is NaOCL 5.25% and look  
  • Andrew Ratsey
    Fresh eyes is always helpful, emergency walk ins are always a stressful situation, you’ve treated the cause of the patients distress perfectly, and instrumented 2 further canals to boot, you’re probably fairly gassed at this point. looking at the rad I… 
  • Duncan Grant
    Doesn’t look that far from Mb1 and with pulpal sclerosis so the entrance might have moved and relocated mesially
  • Daniel Flynn
    Admin
    Amazing tips here. 👌👌
    Get the floor really really clean. I use edta gel mixed with urea peroxide (Endo-prep cream) +/- a brush and then canal seek will stain blue which is easier to see than the caries indicator pastes.
    Often the canal has an acute DB angulation to it from the floor but don’t drill any deeper that where you are at present.
    Ensure you can see the tip of the drill if you decide to remove any more dentine or use ultrasonics (the diamond ball tip or the ED6). Let us know how it goes.
    May be an image of cosmetics
  • Duncan Grant
    Ali Nasseh recommends injecting BioCeramic Sealer in the area
    It should track the canal and be very radio opaque more than CaOH2
    Take PA find the canal then wash it away before it sets
    Rob Jacobs replied