SHOWCASE -Beastly Bifurcation

[Dr. Yanina Figueroa]

Beastly Bifurcation

Featured X-Ray:

Case Summary:

Tooth #14
First Visit
Medical and dental history reviewed.
Diagnostic test performed:
CC: “I have pain to cold drinks and also I have pain at random times during the day especially in the morning”
Cold: +++ and lingering (40s)
Percussion: -
Palpation: -
Periodontal Pockets: M (2), MB (1), ML (1), D (2) DB (1), DL (1), B (1) and L (1)
Diagnosis: Irreversible Pulpitis with Normal Apical Tissues

Files & Products Used:

2 carpules of 4% Septocaine with1/100,000 epinephrine buccal and palatal infiltration. Rubber dam, access done with round diamond bur followed by tapered diamond bur. Orifices detected and instrumented 10mm into canal with a 10 C-file. Then SX Gold by ProTaper was used to flare orifices. Working length determined with a 10 C-file with Morita Apex Locator using RC Prep. At this point only MB, D and P canal were found. Extreme curvature seen on MB canal. All canals were instrumented by hand with 20 K-Files utilizing full strength NaOCl. Crown down instrumentation started with 40 Edge Endo File with 0.4 taper. This was done to open path and prevent file binding in such curved canals. Canals were instrumented as follows: MB to 40, D to 40 and P to 50. MB2 was not fond initially although it was searched for with 1/2 round long bur and BUC-1 ultrasonic tip. Ultrasonic irrigation with NaOCL, EDTA and CHX. Canals were dried with coarse and medium paper points. NaOCl sterilized master cones were placed and x-ray was taken. MB2 root could be seen. Cones removed. Intracanal Ca(OH)2 placed and temporary restoration with cotton pellet and Cavit. Carestream by Kodak CBCT taken and MB2 was seen. Bifurcation of MB form MB2 was very abrupt and MB was almost 90 degrees toward buccal. Post operatory instructions given to patient. Next: Look for MB2 and obturation


Second Visit
Medical and dental history reviewed. Diagnostic test performed and tooth was asymptomatic. 2 carpules of 4% Septocaine with1/100,000 epinephrine buccal and palatal infiltration. Rubber dam, removal of Cavit and cotton pellet with tapered diamond bur. On CBCT MB2 was seen 2mm deep and distally from MB. 1/2 diamond bur and BUC-1 used to find MB2. Then SX Gold by ProTaper was used to flare orifice with RC- Prep. WL determined and it was instrument up to a 15-K file utilizing full strength NaOCl. Crown down instrumentation with Edge Endo Files up to a 35 with 0.4 taper. Ultrasonic irrigation with NaOCL, EDTA and CHX. Canals were dried with coarse and medium sterile paper points. NaOCl sterilized master cones with AH+ sealant were placed and x-ray was taken. Obturation was done with warm vertical condensation leaving 4mm plugs in apex with B&L Alpha. Backfill done with warm soft Gutta Percha. Purple Permaflo Orifice barrier were placed. Temporary restoration with cotton pellet and Cavit. Post operatory instructions given to patient. She was sent back to dentist to obtain permanent restoration. She was told the need for immediate restoration and the impact on the tooth if not obtained in a timely manner. Next: Follow up in one year

Additional X-Rays & Extras:

Pre- Op

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