Save a wisdom tooth? Why not?!
Jon Richards DDS MS
Many people have their wisdom teeth removed because they might be impacted or out of position. Often times, however, a wisdom tooth is in good positin and functional, and a very valuable tooth in the arch. One problem that we encounter in regards to treating these teeth endodontically is 1) visualization because they are so far back in the arch, and 2) amazing variability and complexity of the root canal system. How are these overcome in modern endodontics? Skilled use of the dental microscope and data gained by CBCT analysis.
In this case, the CBCT revealed the roots to be not only thin, but extreme;ly curved in the apical 4 mm with sharp dilacerations. There was also the presence of an MB2 canal, located near the palatal canal orifice. With this information, avoiding pitfalls of seperated instruments and missed canals becomes much more likely. Additionally, the preservation of coronal dentin is possible, because we know “where to go and how to get there.”
This case was treated in two visits with Ca(OH)2 placed for 3 weeks in between appointmetns. 4 canals were instrumented and patency was maintained. Immediately following obturation with warm gutta percha and sealer, a bonded amalgam core was placed while the tooth was still isolated under a rubber dam. The patient is committed to following through with a crown to protect tooth #1 for years to come.