Endodontology, Vol.

14, 2002

Endodontic Miscellany: Conventional

Endodontics for Complex root-canal morphology.
Gupta S*

two on mesial and two on distal side.

Instrumentation was done in a routine manner
for all the canals except the distobuccal canal
for which the reamers and files were precurved.
Starting from no. 15 K flexo file, canal was
prepared till No. 35 with instruments pre curving
them matching the morphology of the root.

Root anatomy is highly complex and

unpredictable. The knowledge of the normal
and its frequent variations can greatly enhance
the success rate of endodontic practice.
Variations in the number and the configuration
of the root canals is not uncommon. Curved
root canals exhibit difficulty is cleaning, shaping
and obturation of the root canal system. This
paper reports on an interesting case of a
mandibular right molar which had three roots
and four root canals. In addition, the distobuccal root had severe mesial curvature in the
apical half of the root. The complex
morphological variation could be successfully
treated using conventional stainless steel hand
instruments with step-back technique and
lateral condensation method of obturation.

After establishing the working length the

canals were instrumented using sodium
hypochlorite and hydrogen peroxide
alternatively followed by irrigation with normal
saline. Access cavity was temporized with
reinforced zinc oxide eugenol cement. Patient
was recalled after 5 days, the instrumentation
was completed using step back technique and
the final rinse with saline. The canal was dried
with the sterile absorbant paper points. Again
the access cavity was temporized with
reinforced zinc oxide eugenol cement. The
patient was recalled after 7 days for completion
of treatment. The patient remained free of
symptoms throughout the course of treatment.
After isolation, the walls of the root canal was
coated with ZnO-eugenol sealar. Master cone
selected for the curved distobuccal canal was
precurved like the used reamers and obturation
of all the canals was done using lateral
condensation technique with the help of the
finger spreaders. The gutta-percha points were
sealed off at the floor of the pulp chamber and
an amalgam restoration was placed. Post
obturation radiograph was taken (Fig. 1).

Case Report
A 9 year old boy reported with pain in
relation to mandibular right first molar. The child
gave a history of renal failure and also
tuberculosis two years back. Clinically the tooth
was carious on the occlusal surface and tender
on percussion. Radiograph revealed the
carious pulp exposure with widening of
periodontal ligament space. It also revealed
unusual root morphology with two distal roots,
one of which showed an acute curvature at in
the middle hand. When the caries was
excavated with a spoon excavator, clinical
exposure of pulp chamber was evident.
Due to history of renal failure and antibiotic
restriction, root canal treatment was the choice
of treatment. After anaesthesia and isolation,
access cavity was prepared, pulp was
excavated and four canal orifices were located,

Discussion
One of the most important aspects of
endodontic treatment is the cleaning and
shaping of root canals. The most desirable
shape of the prepared canal is a progressive
taper with the largest diameter at the coronal
end and the narrowest at the apical
constriction1. A progressive taper allows a

* Jr. President
Deptt. of Dental Surgery
All India Institute of Medical Sciences.
New Delhi - 110029

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Gupta S

Endodontic Miscellany...

It is important that a tooth with complex

root canal morphology be treated properly the
very first time, since endodontic treatment in
such teeth is likely to fail, if not treated carefully.
Park and Fong have reported on a case of a
maxillary molar with complex root canal system
which received multiple endodontic treatment
- both orthograde and retrograde without
success and ultimately required extraction. 9

Conclusion

Fig.1.

Proper care and attention should be

directed in radiographic assessment, access
cavity preparation and exploration to negotiate
extra and curved canals. Hand instrumentation
is a time tested, easy and most economical
method of preparation of root canal system,
even in curved canals. Root canal treatment is
the choice of treatment to save the teeth in
systemically compromised, especially the
young patients.

greater degree of instrument and irrigant

contact with the surfaces of the canal walls
thereby enhancing the effectiveness of
cleaning. 2-5
The tapered preparation is particularly
advantageous in situations where the canal in
filled with gutta-percha points5 for an improved
apical seal,6 and a diffuse distribution of
stresses7. Therefore, when the ideal shape is
achieved, both cleaning and obturation of root
canal are facilitated. However curved canals
are difficult and problematic features such as
elbow and apical zip have been well
documented in curved canals prepared by step
back technique with hand instruments.
Ultrasonic and sonic instrumentation have
gained significant interest as they produce
smooth, progressively tapered canals
regardless of root canal curvatures. However,
deviation of the original canal can occur. In all
the methods of preparation, dentin is
preferentially removed from the convex aspect
of the middle portion of the root canal.8

References
1. Schilder H. Cleaning and shaping the root canals. Dent
Clin N Amer. 1974;18:269-296.
2. Coffae KP and Brilliant JD. The effect of serial
preparation verbus non serial preparation on tissue
removal in the root canals of extracted mandibular human
molars. J Endod. 1975;1:211-214.
3. Walton RE. Histologic evaluation of different methods
of enlarging the pulp canal space. J Endod. 1976;2:304311.
4. Bolanos OR and Jensen JR. Scanning electron
microscope comparisons of the efficacy of various
methods of root canal preparation. J Endod. 1980;6:815822.

In this case the conventional hand

instrumentation technique with K flex files, precurved to match the anatomy of the curved
canal was used for biomechanical preparation
of the curved distobuccal root canal.

5. Weine FS. Endodontic Therapy 1982,3rd Ed CV Mosby,

St Louis pp259,283.
6. Allison DA, Weber CR and Walton RE. The influence
of the methods of canal preparation on the quality of apical
and coronal obturation. J Endod 1979;5:298-304.
7. Harvey TE, White JT and Leeb IJ. Lateral condensation
stress in root canals. J Endod. 1981;7:151-155.

Lateral condensation technique was used

for obturation with gutta-percha points with the
help of finger spreaders. This technique is easy
to perform and also cost effective giving optimal
apical seal. The post obturation radiograph
revealed well condensed and sealed four
canals.

8. Targ MPF and Stock JR. The effect of hand, sonic

and ultrasonic instrumentation on the shape of curved
root canals. Int Endod J . 1989;22:55-63.
9. Park JS and Fong CD. Hidden abnormal complexities
of the root canal system: A case report. Columbia Dental
Review. 2000;5:14-16.

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