Patient presented with #1-3 pulp necrosis and chronic apical abscess. Due to missing #1-2, mesially tilted tooth #1-3 had been restored as #1-3 and #1-4 splinted crowns in the place of #1-2 and #1-3. The clinical picture shows a ceramic interdental papilla which covers the root of tooth #1-3.
The key aspects in treating such a case are as follows:
- reviewing the risks of the procedure in detail with the patient (i.e. possible damage to the restorative work to the point of needing replacement, possible mishaps during the endodontic treatment [perforation, instrument fracture], etc.)
- through assessment of the tooth/root under the crown using a probe and by palpating the root
- good understanding of the root angulations in mesial-distal and buccal-lingual directions
- planning for initial access location
- good isolation with a stable clamp that can be placed over the root
- constantly aligning the bur with the long access of the root while drilling in the center of it
- and finally, Patience, Patience and more Patience!