Date: September 2025
1. Patient Information
Gender: Male,Age: 34 years old
2. Chief Complaint
Severe pain and swelling in the upper right facial region.
3. Clinical Symptoms
- Severe, throbbing toothache
- Pain exacerbated during chewing or biting
- Radiating pain to the ear, head, and eye
- Fever
- Halitosis (bad breath) and unpleasant taste in the mouth
- Facial swelling
4. Radiographic Examination
- Periapical X-ray of Tooth #17
- Panoramic X-ray
5. Diagnosis
- Chronic Periapical Abscess (Tooth #17)
- Failed Previous Root Canal Treatment
- Missed Buccodistal (BD) Canal
- Missed Mesio-Buccal 2 (MB2) Canal
6. Treatment Plan
Retreatment of Root Canal (Tooth #17), with emphasis on locating missed canals and achieving thorough cleaning/shaping using Chameleon Pro-Flexi Files (Denco, nickel-titanium heat-activated).
7. Treatment Procedure
7.1 First Visit: Canal Access, Cleaning, and Medicament Placement
A. Initial Canal Preparation
- Access opening created for Tooth #17.
- Missed BD and MB2 canals identified and opened under a dental microscope.
- Working length determined for all canals.
- Initial irrigation performed (details in Section 7.3).
- Intracanal medicament placed.
- Temporary filling material applied to seal the access cavity.
B. Cleaning and Shaping Protocol
Cleaning and shaping were executed using the following instruments and sequence, with Chameleon Pro-Flexi Files (Denco) as the primary nickel-titanium (NiTi) heat-activated files:
- Step 1 (Coronal Third Preparation):
Started with Denco K File #10 for initial canal negotiation.
Followed by Chameleon Pro-Flexi Files (0.1 taper, 0.9 size) at 19mm working length to shape the coronal third.
- Step 2 (MB1, MB2, and BD Canals Preparation):
Chameleon Pro-Flexi Files (0.4 taper) used at 25mm working length, sized from #10 to #35.
- Step 3 (Palatal Canal Preparation):
Chameleon Pro-Flexi Files (0.6 taper) used at 25mm working length, sized up to #50.
C. Intracanal Medicament
Calcium hydroxide paste was placed as intracanal medicament, with a 7-day interappointment interval
7.2 Second Visit: Final Irrigation, Obturation, and Tooth Buildup
A. Final Irrigation Protocol (Detailed in Section 7.3)
B. Obturation
- Root canal obturation performed using Total Fill (BC) Sealer (FKG)and Denco Cuttapercha Points.
- A small perforation (identified during retreatment) was sealed with Mineral Trioxide Aggregate (MTA) under microscopic visualization.
C. Tooth Restoration
Post-obturation buildup of Tooth #17 was completed to restore structural integrity.
7.3 Irrigation Protocol (Both Visits)
First Visit Irrigation
- 25% Sodium Hypochlorite (NaOCl) irrigation for 35 minutes.
- Activation with Emate Activator EA-9.
- Rinsing with normal saline.
- 2% Chlorhexidine (CHX) Solution irrigation.
- Reactivation with Emate Activator EA-9.
Second Visit Irrigation
- 25% Sodium Hypochlorite (NaOCl) irrigation for 35 minutes.
- Activation with Emate Activator EA-9.
- Rinsing with normal saline.
- Ethylenediaminetetraacetic Acid (EDTA) Solution irrigation.
- Reactivation with Emate Activator EA-9.
- Rinsing with normal saline.
- 2% Chlorhexidine (CHX) Solution irrigation.
Final activation with Emate Activator EA-9.
8. Treatment Outcome
Post-treatment, the patient reported complete resolution of pain, facial swelling, and other symptoms. The patient is currently comfortable, with no signs of recurrent infection.
9. Follow-Up Plan
A recall appointment is scheduled 6 months post-treatment to evaluate periapical healing via radiographic examination and clinical assessment.
10. Key Observations on Chameleon Pro-Flexi Files
The Chameleon Pro-Flexi Files (Denco) demonstrated excellent performance during the root canal retreatment:
- The heat-activated NiTi design enabled efficient negotiation of narrow, missed canals (especially MB2 and BD), reducing canal transportation risk.
- The variable taper options (0.4, 0.6) and size range (#10–#50) allowed precise shaping of different canal anatomies (coronal third, MB1/MB2/BD canals, palatal canal).
- Smooth file progression minimized procedural errors, supporting thorough cleaning—critical for resolving the chronic periapical abscess from the failed initial root canal.
