Oops

[macadoo]

I had this patient in today.  I was in Vancouver for an endo course when this patient came through recall, and the retired doc here was subbing for me that day.  He was schedule for a new crown on #22 due to recurrent caries.  Once I removed the existing crown today, we discovered substantial recurrent caries on #21.  We discussed some options for both teeth, given the restorative prognosis was not strong on either tooth, and the patient finally decided to RCT #22 to save as a future overdenture abutment (pt. has full upper denture) and EXT #21.

I was shocked that we didn't expose the canal orifices during the caries excavation.  I had my assistant place the dam while I prepped a tooth for a crown in the next room.  I came back, and she had the dam in place, Opaldam sealing everything up nicely.  I started moving down the root, but no canals yet.  I got out the Munce burs and ultrasonic and started going deeper using the scope that I'm demo'ing.  I finally felt the Munce bur sink into the canal and took a look.  I did a double-take.  It looked like I had hit gutta percha…WTF.  I started working a 10 file into the canal, no bleeding.  Went 10-8-6, 10-8-6 until I was a fair length down the canal, but the apex locator was being very wonky.  I decided to take an x-ray while out on some hygiene checks.  Damn….perfed, and not even close to the right angulation.  I decided to remove the Opaldam (placed by assistant), to find that she had covered up a good bit of the excavation site with the material.  Totally threw me off…always the assistant's fault, right?

I changed the orientation distally and immediately found both canals.  Enlarged both to a #40/.04 EdgeFile X7, obturated with WVC and AH Jet.  Repaired the perforation with BioDentine and sealed the access with Fuji Miracle Mix with Fuji II LC over that.