Dealing with intricate root canal system
24/03/2025
Fellow
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Every clinician aims to achieve the best treatment outcomes of endodontically treated teeth. To obtain the best results, one must diagnose the condition very well.
Therefore, complete knowledge of root canal morphology with comprehensive understanding of the root canal system complexity is particularly important in clinical practice to reach the desired treatment.
Most of the human root canals have mutiplanar curvatures and to the multiple degrees, suggesting that a tooth with a straight root canal and a single foramen is the exception rather than the rule.
Cleaning & Shaping of the root canal system has been recognized as one of the most important step that can impact the subsequent stages of root canal treatment. But this step can become extremely difficult in severely curved canals.
There is some errors that may happen during shaping of such canals .
Errors include transportation, ledges, perforations, instrument separation, asymmetrical dentine removal, and alterations of the internal anatomy A thorough assessment of the preoperative radiographs, careful and a meticulous approach can yield into a safe and a successful endodontic treatment of such teeth.
Fig. 1
A 16 years male patient was referred to my clinic, with chief complaint of pain in lower right region.
Clinical examination revealed mandibular right 1st molar have deep carious lesion.
The tooth was tender on percussion.
The radiographic examination revealed the radiolucency involving the mesial root apex. And observed sever curvature in both roots .
A diagnosis of symptomatic Apical periodontitis.
Root canal treatment was planned .
Fig. 2
I had treated the same patient 3 years before on the opposite side of the mandible
Fig. 3
Here is the treatment I did three years before
Fig. 4
After giving the anesthesia, cleaning the tooth.
Fig. 5
Isolation the tooth with a rubber dam
Fig. 6
Working length measurement
Fig. 7
Dealing with curved canals is a manual game .
Fig. 8
After cleaning and shaping, the tooth is ready for obturation.
Fig. 9
Obturation by modified hot technique with BC sealer.
Fig. 10
Post operative X-ray
Fig. 11
About the author:
Dr Mohammed Khaleel
B.D.S Hawler medical university /college of dentistry 2011
Key opinion leader for Denco
Conclusions
Management of curved canals can be time consuming, challenging and frustrating.
A sound knowledge about internal anatomy of the tooth, through assessment of preoperative radiographs is crucial prerequisite in managing curved canals.
It is essential first negotiate the canals by hand files and then using rotary files tapered four with copious irrigation in between each file.
Bibliography
- Balani p, Niazi , Rashid H. A brief review of the methods used to determine the curvature of root canals. J restor dent. 2015;3(4):57.
- Peters OA. current challenges and concepts in the preparation of root canal systems: A review. J Endod. 2004;30(8):559-67.
- Lain N, Tushar S. Curvedcanals: ancestral files revisited. Indian J Dent Res. 2008;19(3):267-71.
- Mcspadden J. Masteiing endodontic instrumentation. canada: cloudland Institute; 2007.
- Ansari I. Maria R. Managing curved canals. Contemp clin dent 2012;3(2):237-41.
