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Management of Dilacerated and S-Shaped PDF
Management of Dilacerated and S-Shaped PDF
4520
Case Report
Dentistry Section
Root Canals - An Endodontist’s Challenge
NASIL SAKKIR1, KHALEEL AHAMED THAHA2, MALI G NAIR3, SAM JOSEPH4, CHRISTALIN. R5
ABSTRACT
The unique morphology of dilacerated and S-shaped root canals often pose utmost challenges in their endodontic management. Common
causes of failures in such cases are primarily related to procedural errors such as ledges, fractured instruments, canal blockages, zip and
elbow creations. Knowledge of dental anatomy and its variations is essential for the success of endodontic treatment. A clinician is required
to have an insight of the morphology of tooth related to its shape, form and structure before commencing treatment. Routine periapical
radiographs aids in assessing these morphological variations in the root canal system. This article gives a review of the literature and reports
an interesting case of dilacerated and S-shaped root canals of adjacent teeth in the same patient.
Case Report estimated length till the curvature was marked on the engine-driven
A 19-year-old female reported to the Department of Conservative instrument and coronal flaring was done. Gate-Glidden (GG) drills
Dentistry and Endodontics, with pain in relation to upper right were used for orifice enlargement up to size No 3. Working length
posterior teeth. Clinical examination revealed maxillary right first and was then confirmed using an apex locator (Root ZX, J. Morita, Japan)
second premolars having temporary restoration, which was placed in both the teeth. Sequential filing of the curved canals was done
in a private clinic two months back. Both the teeth were tender using nickel titanium (NiTi) hand files No. 15, 20, and 25 (Mani, Inc,
on percussion. Medical history was non-contributory. Radiographic Japan) to the working length. The apical portions of the canals were
examination revealed that the temporary restorations were extending prepared using short amplitude filing. Special emphasis was placed
into the pulp chamber of the involved teeth. The roots of 14 were on frequent irrigation of the root canal and recapitulation was done
doubly curved (Bayonet or ‘S’ shaped) and that of 15 showed a to avoid blockage by dentinal debris and to remove the necrotic
sharp curvature at middle third [Table/Fig-1]. From the clinical and remnants of the pulp tissue. Final cleaning and shaping was carried
radiographic findings, a diagnosis of previously initiated therapy out using Hyflex CM rotary files up to 4% 40 size of the instrument.
associated with symptomatic apical periodontitis was made in Calcium hydroxide was used as an intracanal medicament and
relation to 14 and 15. Prior to the formulation of endodontic therapy closed dressing was given for six days.
the degree of curvature was determined by using Schneider method In the next visit, the canals were flushed with saline and dried
and it showed severely curved canals in relation to both the teeth. with paper points. A master cone radiograph was taken with 40
With informed consent, local anesthesia was administered using size 4% gutta percha in both the teeth [Table/Fig-3]. The lateral
2% lignocaine and 1:100000 Adrenaline and Endodontic therapy condensation method of obturation was performed using AH Plus
was initiated under rubber dam isolation. Temporary restoration sealer. The post-obturation restoration was done with composite
was removed and the access cavity of 14 and 15 were modified. resin to maintain a good coronal seal [Table/Fig-4]. The patient was
The pulp chamber was irrigated by following standardized irrigation given postoperative instructions and recalled for further follow up.
regimen using 5.25% of sodium hypochlorite (NaOCl), 17% ethylene At three months review, the patient was absolutely asymptomatic
diamine tetraacetic acid (EDTA) and physiological saline. For and there was no radiographic sign of any periapical disease
verifying the patency of the root canals, No.8 and 10 stainless steel [Table/Fig-5].
K-files (Mani, Inc, Japan) were used. No.15 K file glide path was
ascertained up to the radiographic working length [Table/Fig-2]. The
[Table/Fig-1]: Preoperative radiograph showing dilacerated canal in relation to 15 and Bayonet or S-shaped root canals in relation to 14.
[Table/Fig-2]: Working length radiograph [Table/Fig-3]: Master cone radiograph. [Table/Fig-4]: Post obturation radiograph [Table/Fig-5]: Three months
follow-up radiograph
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PARTICULARS OF CONTRIBUTORS:
1. Endodontist, Kerala Institute of Medical Sciences, Thiruvananthapuram, Kerala.
2. Resident, Department of Conservative Dentistry & Endodontics, Government Dental College, Thiruvananthapuram, Kerala, India.
3. Professor, Department of Conservative Dentistry & Endodontics, Government Dental College, Thiruvananthapuram, Kerala, India.
4. Professor & Head, Department of Conservative Dentistry & Endodontics, Government Dental College, Thiruvananthapuram, Kerala, India.
5. Associate Professor, Department of Conservative Dentistry & Endodontics, Government Dental College, Thiruvananthapuram, Kerala, India.