Here too, the operating microscope is an indispensable appliance.
The bottom of the pulp chamber is inspected accurately as to possibly missed canals. Also a careful look is taken at the presence of fractures.
Methylene blue creeps into every cavity or crack and is a wonderful aid to trace (extra) canal entrances. Right from the beginning there is almost constantly Sodiumhypochlorite in the pulp chamber. The advantage is that the pulp chamber – as it were – is leached out so that details are getting more and more visible. Furthermore, the hypochlorite creeps into all cracks and canal entrances, so that the antibacterial effect starts immediately and can do its job as long as possible.
When looking for the canal entrances, use is made of various special drills and ultrasonic tips. It’s important that such instruments have a long shaft so that the bottom of the pulparoom is fully visible during the preparations. Once a canal entrance has been found and there’s a doubt whether this really is a canal or possibly a perforation, then the apex locator is an indispensable appliance. Should there be a perforation, then immediately a signal will be given as if there’s a file beyond the apex. When all canal entrances have been found, the removal of old canal fillings etc. can start.