The value of the microscope
Jon Richards DDS MS
This is a good case clearly demonstrating the advantage of using the dental operating microscope. Root canal therapy had been previously attempted but referred due to limited patient opening and calcification which had occluded the canal orifi.
The photographs show the difference in appearance between the dentin walls and the chamber calcifications. The darker color provides a map to follow that will eventually lead to the points of negotiation for each canal.
Often times the canals have narrowed coronally and can be very difficult, if not impossible, to locate without the benefit of increased magnification and illumination. Without these two aids, the practioner is left only to searching in possible areas, hoping to get lucky. Add the additinal data gained by the CBCT scan, and I was able to go right to each canal confidently- but more importantly conservatively. This preserves the axial wall (a.k.a pericervical) dentin . It is now suspected that preservation of this structural dentin has a large association with long term success. In this case, I would have prefered the opportunity to make a smaller access in the crown, but this one could have been worse. These benefits (microscope, CBCT) are advantageous for every patient, on every case that is endodontically treated.
Following treatment, the access was repaired with amalgam retained by the “tripod” effect into the canal orifi. RPD abutment teeth will go through additional compressive and oblique forces, so amalgam was used due to its rigidity in bulk and long term wear characteristics. Additionally this is in a non-esthetic area so its visibility will not be a problem.