15/05/2022
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ENDODONTIC TREATMENT OF UPPER LEFT FIRST MOLAR
A 44-year-old male presented with asymptomatic chronic apical periodontitis on tooth No. 26.
he did one session pulpotomy(only access)Three months ago in another clinic with another appointment but he didn't go .
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the patient had no significant medical issues.
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by clinical examination there was a temporary restoration with Remnants of old Amalgam filling in the access cavity of 26.
the 25 had previous endodontic treatment with occlusal amalgam restoration with out any symptoms
* A periapical radiograph taken revealed a large radiolucent lesion related to 26 .
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treatment was initiated,
*DAM APPLICATION
*temporary filling was removed
*negotiate the canals to detect the full working length
*p..27
*mb1&mb2...25
*DB...25
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during negotiation Palatal canal multiple catches in different direction was felt as shown in x rays which means there is more than one lateral canal (apical ramification)
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APICAL RAMIFICATION (SIMPLE DEFINITION)
Apical delta (or apical ramifications)
The region at or near the root apex where the main canal divides into multiple accessory canals (more than two)
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Due to the difficulty to clean the apical part mechanically with rotary files in such case i try to scout the laterals with manual file . time after time i can reach to file 20&25 k&h file .***********************************
THE MAIN PALTAL CANAL PREPARED BY ROTARY FLLE TO 40 #4
SHORTER THAN THE APEX BY 3MM Due to the difficulty to clean the apical part mechanically with rotary files AND TO AVOID ledge formation or perforation.
**MB1&MB2&DB
reach to 35 #4
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Then comes the big role of IRRIGATION
the irrigation time in final rinse was prolonged for both NAOCL 5.25% and EDTA 17% for 2min with activation by ultra x .
***Final rinse protocol was Naocl 5.25%-- EDTA17%-- N/S--- Naocl5.25% --- N/S .
***OBTURATION DONE BY BIOCERAMIC SEALER WITH WVC (LOW TEMP)
# # # # KEEP NOTE-------
IRRIGATION, one of the most important steps in endodontics, which enables us to clean even the parts that we can not achieve mechanically, such as various anatomies of the endodontic system, lateral canals, apical ramification, etc
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