Page 47 - The Beauty and Sorrow in Endodontics-Chapter 2

motion is then utilized to clean and shape the canal. A 0.10 tapered cone
4
was unable to reach the WL (Fig 28B), and a series of files with frequent

recapitulation was used to widen the middle and coronal thirds of the canal.
Small up-and-down filing motions (1~2mm) were done to continue to

smoothen the irregular apical dentin wall along with copious irrigation.
Once ideal placement with adequate tugback is achieved with the selected

master cone (0.10 taper, Fig 28C), it is then disinfected. Final irrigation with

QMix and the canal was dried with paper points. It is then obturated using
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warm vertical compaction technique (Fig 28D, 28E). Immediately
#
following the completion of 45 retreatment, a fiberpost and resin buildup
was completed to seal the occlusal access (Fig 28F).

2) Follow-up

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~6-months – Near complete healing of 45 apical lesion with reappearance
of its lamina dura and some resorption of the extruded sealer
(Fig 28G). The patient reported no swelling in the lower right

#
area and 45 responded normally to both percussion and
palpation tests.

#
#
1.5-years – Complete reformation of the lamina dura around 45 and 46
with more resorption of the extruded sealer (Fig 28H).
1
Note For other treatments for this patient, see “cases 26, 27”
2 The progressive dilution of NaOCl is to prevent any damage to any vital tissue
close to the apex of the tooth being treated. The same concept should be applied

in cases with apical resorption, any apical destruction or perforation, and

immature or open apices. In cases with closed apices with no transportation of
the canal opening, dilution of NaOCl is not recommended.

3 For information on the working length terminology, see “Working Length”
4 For information on the envelope of motion in cleaning and shaping and final

taper selection, see “Cleaning and Shaping”
5 To understand the Schilderian Vertical Compaction technique, see “Warm

vertical compaction technique” and “Summary of Schilderian techniques”.

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