THE CURVE CONUNDRUM: ENDODONTIC MANAGEMENT OF A DILACERATED THIRD MOLAR

Fig. 1

PREOPERATIVE ASSESSMENT:
Mesial canal curvature- 60 degree

Fig. 2

Distal canal curvature- 30 degree

Fig. 3

The radius of curvature- 14 mm

Close proximity to the mandibular canal.

Pulp calcification was seen with the distal root.

AAE DIFFICULTY ASSESSMENT- HIGH

(http://www.aae.org/caseassessment/)

Fig. 4

• ANESTHESIA AND RUBBER DAM APPLICATION
• ACCESS OPENING:
• Performed using SF 12, followed by safe end (EX-24) to achieve complete deroofing.
• Ultrasonic used to refine the access.

Fig. 5

Classic crown down technique was used with CM wire files for mechanical preparation. 

• Preflaring is done with 17/08,  2 mm into the orifice.
• 25/06 was inserted with hand till point of resistance and then the file was activated in a 1 mm stroke with pecking motion apically. 
• The sequence was repeated until the file penetrated 13 mm i.e. just above the curvature.
• Working length was then calculated using EAL (Morrita Root ZX 2) using the #8K hand file. 
• The glide path was achieved by sequential hand filing with #8K, #10K till they were passive.
• Shaping was completed with heat treated files to apical size of 20/006 in mesials and 25/06 in distal.

Fig. 6

OBTURATION AND CORE BUILDUP

• Care was taken to keep instrumentation at apical constriction to avoid any mishaps due to close proximity to the mandibular canal

• Cold hydraulic obturation with bioceramic sealer was performed.
• Composite core was done in the same appointment. 

Fig. 7

About the author:

Sagar Shah