Endodontic case study: Challenges of a bifurcated canal

Oct. 12, 2013
Shawn Velez, DDS, presents an endodontic case study in which tooth No. 21 was diagnosed with pulp necrosis and asymptomatic apical periodontitis.

Clinician: Shawn Velez, DDS, of Aiken, S.C.

Description of tooth, position, and morphology: Tooth No. 21 diagnosed with pulp necrosis and asymptomatic apical periodontitis. Tooth in normal inclination. This tooth presents with a single root and type IV canal system (one canal bifurcating into two canals).

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Pre- and postop comments: Access was made through PFM crown and glidepath established with a Lexicon® #15 Flex SSK hand file. Working length confirmed at 17.0 mm. Final shape was created using the WaveOne® Primary file in the presence of copious sodium hypochlorite.

QMix 2in1 irrigation solution was used as the final irrigant, using the ProRinse® irrigation needle. The EndoActivator was used to agitate all the irrigants. ThermaSeal® Plus Ribbon® sealer and GuttaCore® obturator were used to obturate. Post space was made with a GT® Post drill.

"This young lady came in to see me with a necrotic No. 21," Dr. Velez said. "Activated irrigation with NaOCl/QMix got me a surprise on the postop (radiograph).

"Since the canal bifurcated hard at the distal," he said, "Flex NTK hand files were used to prepare this area. The ability of GuttaCore to obturate the challenging apical anatomy was greatly enhanced by deep delivery of sodium hypochlorite and QMix using the ProRinse irrigation needle and the EndoActivator."


Shawn Velez, DDS, is a graduate of the College of Lake County, Grayslake, Illinois, where he graduated with highest honors. During his undergraduate studies, Dr. Velez served as a congressional intern for the Honorable John Edward Porter. He received his dental degree from the University of Illinois College of Dentistry and his certificate in endodontics in 2004. He is licensed to practice in Georgia, Illinois, and South Carolina. Dr. Velez has been involved in numerous research projects and professional exhibits associated with his specialty. Recently, several of his cases have been published in Pathways of the Pulp, Tenth Edition. He currently serves as a key opinion leader and advocate for DENTSPLY Tulsa Dental Specialties. Through his hands-on technique courses, Dr. Velez provides continuing education to many of the Southeast’s general dentists. He has also served as a faculty member at the University of Illinois College of Dentistry. He is a diplomate of the American Board of Endodontics and a member of the American Dental Association, Illinois State Dental Society, South Carolina Dental Association, American Association of Endodontics, Chicago Dental Society, Aiken Dental Society, Augusta Dental Society, and Edgar Coolidge Endodontic Study Club.

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