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).