UR1 Endo Difficult Obturation and Vertical Margin

Management of an Ovoid Root Canal in a Maxillary Central Incisor with Restorative Complications

Overview:

In this video, Jon discusses a retreatment case involving an upper right central incisor presenting with persistent discomfort. He focuses on the technical challenges of achieving apical control in an ovoid canal and the strategic use of vertical preparations to preserve tooth structure.

The Case & History:

A patient presented with a history of lingering discomfort associated with the upper right central incisor. Clinical examination revealed excellent general oral hygiene; however, the gingiva surrounding the affected tooth was inflamed and exhibited bleeding on probing. The tooth had been previously restored with an E-max crown, which radiographs showed was poorly fitted at the horizontal margins. Further radiographic and CBCT analysis revealed a periapical radiolucency and an existing carrier-based obturation. Upon removal of the crown, it was noted that the previous preparation had been quite aggressive, leaving limited remaining tooth structure.

The Clinical Problem:

The clinician faced two primary challenges: ensuring a predictable apical seal within a wide, ovoid canal and restoring a tooth with a significantly compromised ferrule. During obturation, the initial master cone was found to be overextended. Jon explains how to adapt the obturation technique using a finger spreader and accessory cones to stabilise the master cone, preventing it from being displaced during warm vertical condensation. Furthermore, he addresses the need to overbuild the composite core and utilise a vertical preparation to maximise structural integrity and allow for soft tissue healing before the final restoration.