Double visualization of root canal treatment with CBCT and microscope

Abstract

In root canal retreatment, the outcome may not be always favorable in the standard procedure. Identification of the cause and direct approach to it may be a key point to success. A 58-year-old male patient visited Okaguchi dental clinic in Tokyo, Japan. His chief complaint was discomfort on the mandibular right second premolar. He had a slight percussion pain and sinus tract in this tooth. The dental X-ray showed a periapical lesion around the root canal-treated tooth. From CBCT images a radiopaque material was observed in periapical lesion. Gutta-percha was removed with ultrasonic files (Mani, Japan) and micro excavator (Seto, Japan) using microscope (Karl Zeiss, Germany). The radiopaque material in periapical lesion was also removed with micro excavator and it was gutta-percha. Root canal was filled with MTA (ProRoot MTA, USA). After treatment, all of his symptoms disappeared. At the 3-year follow-up, periapical lesion was completely healed. Clinicians usually treat blindly with hand or rotary files and 2-Dimensional X-ray. However, CBCT reveals more detailed information on the morphology and problems of the root canals. In this case, it was presumed that gutta percha outside the apical foramen also became an infection source. To perform all procedures visually, microscope, ultrasonic files and micro excavator were used. For the success of retreatment, it is important to identify the problem in each case and direct approach to it. Double visualization of endodontic treatment using CBCT and microscope is an ideal technique for root canal retreatment.