Management of severe trajectories: a clinical perspective

Fig. 1

A referred case of tooth no. 36 with a previous inadequate treatment due to inability of the referring doctor to deal with due to multiple curvatures

Patient complained of persistent symptoms of apical periodontitis

After analysis of the preoperative radiography , I started to remove the temporary filling then removing the intracanal filling.

Fig. 2

After removing most of the intracanal filling and checking working length 

We should avoid :

• Forcing instruments in a curved canals
• Using stiff and large instruments
• Leaving the rotating file for full length more than just a seconds i.e. just kissing the apical constriction to avoid torsional separation of the file.

Fig. 3

Shaping done safely and here is the final outcome

Fig. 4

Here is a case of tooth no. 48 that the patient insisted to keep  with coronal and severe apical curvature and very small radius

Fig. 5

Scouting done to determine shaping protocol, radius was very small so I decided here to end up at 20.04 and more focus on irrigation

Fig. 6

Final radiography with lateral canals filled

Fig. 7

Tooth no. 16 that is almost SOLID with an old amalgam filling and proximal caries with symptoms of acute irreversible pulpitis

After removal of the restoration and caries excavation, a dedicated ultrasonic tip was used to remove calcification in the pulp chamber and exploring canal orifices 

Fig. 8

First attempt resulted in failure to reach the length due to severe coronal curvature of MB2

Fig. 9

Access cavity modification and orifice relocation done with the help of ultrasonic and orifice opener to reach the full length.

Fig. 10

The final radiography with different angles showing the multiplanar curvature of MB2

Fig. 11

About the author:

BDS - Cairo university 2001

Endodontic specialist.

Lecturer in the field of minimally invasive endodontics.

Part time consultant endodontics in private dental centers in Cairo.

StyleItalianoEndodontics Fellow.