I found you!

Sclerosed canals can be challenging to locate and prepare. Irritants, including bacterial attack from an area of decay, can cause the dental pulp (nerve) to create and deposit more dentine, closing up the root canal space. In the current case there seems to be no obvious sign of an irritant to cause the sclerosed canal, and with further questioning it appears that there was physical trauma to this tooth in the past which caused the speedy laying down of extra dentine. Sclerosed canals do not always need to be endodontically treated but if there is irreversible inflammation or bacterial infection the tooth will need to be treated. Careful accessing, magnification and illumination are essential in treating these difficult cases.

The root canal of the LR3 is just about visible on this radiograph.

Once the canal is found, careful hand filing is carried out with constant irrigation to prevent blockages. In this way a glide path is created, this will give the following larger shaping file enough space to work effectively in removing infected tooth structure. Even with this glide path, the shaping file needs to be used carefully in a sclerosed canal, progressing slowly, irrigating constantly and breaking up debris within the canal with small files (patency filing). This will prevent excessive build up of debris which is more likely from sclerosed canals, allowing the preparation to continue along the natural course of the canal. Once shaped, the canal is irrigated thoroughly with the antibacterial solution.

Postoperative radiograph showing the canal successfully filled to the apex.

The patient was experiencing pain from the LR3 and the preoperative radiograph revealed a periapical radiolucency associated with a sclerosed root canal of the LR3. This is indicative of a bacterial infection present in the root canal system and to treat this the canal must first be accessed. High magnification and illumination with careful tooth structure removal ensures the canal is uncovered and prevents unnecessary weakening of the tooth.

A radiograph is taken with a file in the canal to confirm correct location was achieved.

Once the irrigation has been completed the canal is dried and filled, any bacteria that have managed to escape the disinfection protocols will be entomb and rendered inactive by the root filling. In the absence of any symptoms, a follow up radiograph will be taken in a years time to assess the size of the apical radiolucency, giving us some indication of the healing process.

All in all, a tricky case with a good result.