Case by Dr Jelena Kosoric
Introduction:
Dentistry is often full of surprises, especially when dealing with the intricate anatomy of teeth. This case study explores a scenario where unusual root canal anatomy may present significant challenges during endodontic treatment, highlighting the importance of thorough assessment and strategic planning in managing such complexities.
Clinical Background:
The initial observation of an off-centre root filling raised immediate concerns about potentially missed canals. Indeed, further examination revealed that Subsequent diagnostic evaluations confirmed that certain canals had remained undetected and consequently unfilled during the initial endodontic intervention, resulting in persisting pathologic conditions. We noticed that the lower first premolar exhibited an unusual root anatomy too, suggesting a variation of premolar anatomy in this patient and a challenging re-root treatment ahead.
Diagnostic Insights:
A critical challenge was identifying the presence of two buccal canals, which share a common entrance but diverge deeper within the root. Such anatomical nuances pose complex obstacles, particularly in cases where the divergence occurs more apically, making canal obturation notably difficult.
Re-Treatment Strategy:
The treatment approach focused on meticulous canal identification, careful navigation of the canal system, and strategic decision-making regarding obturation techniques. In this specific case, the buccal canals diverged only 2 mm below the joint canal orifice, fortunately allowing for easier visualisation and photography of the area.
Core Restoration Challenges:
An often-underestimated aspect of endodontic treatment is the core restoration process. Achieving a robust coronal seal and laying a solid foundation for future cuspal coverage restoration are paramount, especially following a lengthy and complex procedure. Expertise and precision during core restoration is crucial for long-term success.
Postoperative Considerations:
Ensuring patient comfort postoperatively involved careful occlusal adjustments to prevent excessive contact on the treated tooth, pending further restorative work by the referring dentist to provide cuspal coverage.
Outcome:
Despite the anatomical challenges and the complexities involved in navigating and treating the canals, the treatment concluded successfully with all canals properly obturated and a strong core restoration established. The patient was left in a comfortable occlusion, with no excessive contacts on the treated tooth, awaiting final restoration.
Reflections:
This case underscores the unpredictability of dental anatomy and the importance of being prepared for surprises. It highlights the necessity for detailed preoperative assessment, the use of advanced diagnostic tools, and a strategic approach to treatment planning.
Learning Points for Dental Professionals:
- Always anticipate anatomical variances and be prepared for unexpected challenges.
- Employ meticulous strategies for canal identification and obturation, especially in complex cases.
- Recognise the importance of core restoration as a key component of successful endodontic treatment.
This case serves as a testament to the complexities inherent in endodontic treatment and the resilience and adaptability of the specialist to overcome them effectively
If you’re encountering complex cases that could benefit from a second opinion, or if your practice requires specialised endodontic services, we invite you to get in touch with Endo Elements. Ensure your patients receive the highest standard of care with our expert team, renowned for our precision and expertise in handling even the most challenging endodontic cases. Contact Endo Elements today and place your patients in the hands of experts.
