Endodontic Treatment of First Mandibular Molar with Severely Curved Roots

Abstract

The apical foramen (AF) varies in size and configuration with maturity. Before maturation, the AF is open. With time and deposition of dentin and cementum, it becomes smaller and funneled. Significantly, the foramen usually does not exit at the true (anatomic) root apex, but it is offset by approximately 0.5 mm and seldom more than 1.0 mm from the true apex. The degree of deviation is unpredictable and may vary considerably from the average, particularly in the older tooth that has undergone cementum apposition. For this reason, root canal preparation and obturation end short of the anatomic root apex as seen in the radiograph. Usually, the AF is not visible radiographically. The clinician relies on averages or electronic measuring devices to determine the extent of canal preparation and obturation. Source of support: Nil Conflict of interest: None CASE REPORTA 30-year-old female was referred from the general dental practitioner clinic. The tooth was opened and formocresol pulpotomy was done; neither fistulae nor edema was observed.A standard endodontic procedure was carried out after local anesthesia of 2% lidocaine hydrochloride containing 1:100,000 epinephrine. A rubber dam was placed for endodontic access; then, the temporary restoration was removed clearly.Examination of the pulp floor with an endodontic explorer revealed three distinct canals -mesiobuccal (MB), mesiolingual (ML), and distal canals (D). A K-type file (Maillefer, Switzerland) was used for gross removal of pulp tissue from the three main canals. The canals were negotiated using a small file size 10 (Maillefer, Switzerland), using 17% ethylenediaminetetraacetic acid (EDTA) (Technical + General LTD London, UK) solution, and then irrigating with 5.25% sodium hypochlorite solution (NaOCl).Determination of working length by Advanced Apex Locator NSK IPEX 2 Locator (Fig. 1) was as follows: MB: 18.5 mm, ML: 18 mm, and D: 21 mm.ProTaper SX (Dentsply Maillefer) was then used to enlarge the orifices of the canals. All canals were chemomechanically prepared using crown-down technique. ProTaper nickel-titanium (NiTi) file sized S1, S2, and F1 were used successively (Fig. 2). The canals were then irrigated by NaOCl and 17% EDTA as irrigating solution.