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Case Studies

Case 1:

De-novo Endodontic therapy of LL6

LL6 associated with intermittent symptoms. A diagnosis was made of chronic periapical disease with suppuration. Root canal preparation using Protaper and Profile rotary files. ‘Dynamic pumping’ with combination of 17% EDTA and 2.5% Sodium Hypochlorite (warmed to 40 degrees Celsius) used immediately prior to obturation. Note communication, via accessory canal, of the radiolucent area associated with the mesial root.

Case 2:

Endodontic retreatment of LL5 and De Novo endodontic treatment of LL6

Access gained through existing crown of LL5. Gutta Percha removed with organic solvent, hand and rotary files. Apical patency achieved (with size #10 hand file). Root canal preparation with Protaper and Profile rotary files.

Access made via existing LL6 crown. Three root canals located and patency filing to size #10. Rotary files used to prepare root canals. Mesial curvature maintained.

Obturation of all root canals achieved using warm vertical condensation of gutta percha using System B and Hot Shot backfill in combination with Tubliseal.

Case 3: Non-surgical root canal therapy of UR 1 and UL 1

Endodontic retreatment of LL5 and de-novo Endodontic Treatment of LL6 Retreatment of LL5

30 year old male patient with large apical radiolucencies associated with both maxillary incisor teeth. Patient also presented with chronic suppuration (labial sinus opposite UL1). There was a past history of trauma as a school boy. Long cone periapical digital radiographs revealed large, underdeveloped root canals and root apices. Evidence of large radiolucent areas associated with both teeth.

Root canals of both teeth were opened up and root canal systems of both teeth cleansed with a combination of warm 2.5% sodium hypochlorite and 17% EDTA. Following thorough drying both teeth were finally obturated using MTA apical plugs and warm Gutta Percha Back Fill (Hot Shot) with endodontic sealer. Both teeth were restored with composite resin access restorations to create effective coronal seal. This treatment was performed over two appointments and the patient reviewed at 24 months. At this appointment patient confirmed that both the labial sinus and his symptoms had resolved. A review radiograph confirmed apical healing.

Case 4:

The Non-Surgical Re-treatment of LL6

Patient was referred to Hodsoll House for specialist endodontic treatment of LL6. The tooth was found to be symptomatic and tender to pressure. It had been previously root-treated and restored with a porcelain-fused-to-metal-crown many years earlier. Long cone pre-operative radiograph revealed sizeable radiolucency associated with the mesial root. The existing root fillings were noted to be sub-optimal. All were short of ideal working lengths. There was no evidence of iatrogenic problems such as ledges, perforations or file separations. All root canals were prepared with the aid of an organic solvent to remove the gutta percha and rotary instruments. Cleansing was achieved with warmed 2.5% sodium hypochlorite and 17% EDTA. The root canals were obturated three dimensionally with warm vertically condensed gutta percha (using System B and Hotshot). The tooth was restored by the referring dental practitioner with a Nayyar amalgam core and a new porcelain-fused-to-metal crown. The patient was reviewed 12 months post-operatively. There were no clinical signs of infection and a digital radiograph confirmed positive signs of bone healing.

Case 5:

Re-treatment of UL5 and MTA repair (2007) and de-novo endodontic therapy of UL6 (2013)

A 50 year old male was referred to Hodsoll House in 2007 by his dental practitioner due to problems with UL4. This tooth had been previously root treated but was symptomatic. The tooth was tender to both palpation and to percussion. The crown of the tooth was within the cosmetic envelope. Good periodontal support associated with UL4 but there was evidence of an apical radiolucency and a likely mesial iatrogenic perforation. The treatment plan was to investigate the UL4, under an operating microscope, with the hope that it would be possible to locate, cleanse and obturate two root canals to ideal working lengths and repair with MTA the likely perforation. This treatment was carried out in 2007. It was advised that the tooth should be restored with a Nayyar core and crown to maintain coronal protection and seal.

In 2013 the patient was re-referred by the dental practitioner. The patient complained of acute irreversible pulpitis UL6. Deep recurrent caries was noted to be associated with the existing intermediate restoration. The pre-operative digital radiograph confirmed significant root curvature of the mesio-buccal root and long roots. The working lengths were estimated to be 26mm.

The UL6 tooth was opened up and instrumented with a combination of hand and rotary files (working lengths of the four root canals found was 25-26mm). The tooth was cleansed with warmed 2.5% sodium hypochlorite and 17% EDTA. Obturation was achieved with warm vertical Gutta Percha (System B) and warm back-filling (Hot Shot) (together with endodontic sealer). UL6 was found to be asymptomatic at review. The patient was referred back to the dentist with advice to place indirect cuspal-protection restorations for both UL4 and UL6.

Case 6:

Removal of fractured endodontic File from distal root of LL6 and endodontic treatment of tooth with difficult sclerosed root canals

Patient referred to Hodsoll House with symptomatic LL6. Unfortunately the referring dental practitioner had experienced difficulties finding the sclerosed root canals of this difficult tooth. The practitioner had clearly informed the patient of the problem and offered various options, including referral to a specialist endodontist. At Hodsoll House the metallic instrument was removed with fine piezon-ultrasonic instruments. The sclerosed root canals were located and carefully instrumented to full working length (and patency) with small hand and rotary files. The tooth was then thoroughly cleansed and obturated with vertically condensed Gutta Percha. The tooth was asymptomatic at the obturation appointment and the dental practitioner was advised to place an indirect cuspal protection restoration to achieve a good coronal seal and reduce the long-term risk of crown fracture.

Case 7:

Unsuccessful attempt at root canal treatment UR67 – presence of fractured files in MB and Pal roots of UR6 & MB and DB canals of UR7

50 year old male referred to Hodsoll House. Acute periapical abscess from UR67 when abroad. Emergency dentist outside UK attempted RCT UR67. Unfortunately separated instruments were radiographically present in both teeth.


    At Hodsoll House, all endodontic treatment is carried out under rubber dam isolation and microscopic magnification using a Zeiss microscope. Rotary and conventional files are used for instrumentation.


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