The reference points cited in the first clinical case when creating the
access cavity are not applicable in this case. For example, there is no
longer the feeling of emptiness during pulp effraction, there is no
cleavage plane and the pulpolite cannot be mobilized.
In this case, we proceeded by deepening the perimeter of the access
cavity step by step with a long-necked ball burr, then began
circumferential pulpolite clearance with ultrasonic diamond inserts
(ET18D / ETBD), giving priority to freeing the canal entrances (Fig.
11.12.13).
Using the same long-necked ball bur, the calcified tissue was abraded
under direct visual control, using the color difference (between cameral
dentin and calcified tissue) as a milling guide. This was continued
until complete removal of the pulpolite and release of the canal
orifices. Once free, root canal negotiation and instrumentation were
carried out step by step, with continuous renewal of the irrigation
solution (Fig.14.15.16).