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Endodontics Redefined

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Endodontics Redefined

Endodontics Redefined is a small attempt to make sure everyone understand and deliver their best effort in terms of Endodontic treatment.

Today in the era of high end gadgets, we lack the understanding of basic principles and the science..

14/09/2025

Premolars are possibly the most complex structures in endodontics.

Yet another premolar with a midroot split along the buccal root, scouted and prepared using minimally invasive approach.

Vertucci] showed that the incidence of three canals in maxillary first and second premolars were 5% and 1%, respectively. According to Pineda and Kuttler the incidence of three canals in maxillary first and second premolars were 0.5% and 0%, respectively.

📌A careful clinical examination can furnish the clinician with signs that are typical of the presence of a third root. In the buccal aspect, the gingiva has a flat appearance and its convexity is not in harmony with the adjacent elements.
📌Probing can disclose the presence of a buccal furcation; sometimes a small depression can be present, starting from the buccal roots furcation and proceeding in a coronal direction for a few millimeters, remaining mainly localized in the cervical third of the tooth crown.
📌Examination of the pulp chamber is one of the diagnostic measures.
📌when the mesiodistal diameter of the middle third of the root is equal or greater than the mesiodistal diameter of the crown, a third root canal is likely to be present.

Keep scouting, Cheers

07/09/2025

A four-rooted maxillary second molar is a rare but documented dental anomaly where the tooth presents with an extra root, typically a palatal root, in addition to the standard three roots. This variation in root anatomy, with an incidence of less than 2.5% in the population, necessitates careful planning for procedures like root canal treatment

In this anomaly, there is an additional root. Often, this involves an extra palatal root, leading to a configuration of two palatal roots and two buccal roots, or other variations. traditional radiograph with a shifted projection angle can still play an important role.

Anatomy has no limits!!

Keep scouting, cheers.

31/08/2025

One of the most complex aspects in managing lower molars and also the reason for higher failures with this tooth, due to a complex nature of the intricacies residing.

Isthmus joining partially or completely, distal canals need a deliberate access and planned approach to take care of this complex anatomy.

type V isthmus is defined as a true communication or corridor throughout the section. Where your limitations with endodontic instruments would clearly be visible.

Keep scouting Cheers..

Reference.
Root and canal anatomy of mandibular first molars using micro-computed tomography: a systematic review
Hasan M. AL-Rammahi, Wen Lin Chai

24/08/2025

Possibly one of the toughest retreatment cases, in recent times.

Severely ledged and blocked canals, that makes reaching the root end of the tooth "a BIG challenge"!!

Few tips to manage such cases,

Recognition of a ledge is the first step in its management; this might be by clinical or radiographic observation. When a ledge is formed, the canal is usually “straightened” at that point. Suddenly the file no longer negotiates the curve but catches on a “dead end”.

The most critical requirements for bypassing the ledge are determination, perseverance, and patience. Generally when attempting to bypass a ledge, the shortest file that can reach the ideal working length should be selected. Shorter instruments provide more stiffness and allow the clinician’s fingers to be placed closer to the tip of the instrument, which results in greater tactile sensation and thereby helps to provide more control over the instrument.

Whenever resistance to negotiation is met, the file should be retracted slightly, rotated, and then advanced again, with the precurved tip facing in a different direction. This action should be repeated until the file bypasses the ledge. It is important to appreciate that the root canals are frequently more curved than the roots that contain them. Hence, a small file (such as a No. 10 or 15 file) with a distinct curve at the tip (that is, in the apical 2 to 3 mm) should be used initially to explore the canal to the apical foramen.

Hope this would help you all manage those tricky ledges.

Keep scouting Cheers!!

18/08/2025

Scouting has no limits!!

Deep split, also known as Vertucci type V canal anatomy, is one of the most challenging anatomies in root canal treatment.

It presents a situation where one canal leaves the pulp chamber and divides short of the apex into two separate apical foramina (1-2).

Yet another challenging premolar intricacy managed using pure manual files.

Radiographs, especially cbct, could be of great help in diagnosis. But keep in mind that deep split is not necessarily visible on periapical x rays. Magnification and illumination with good control over your manual tools is essential.

Keep scouting!! Cheers.

08/08/2025

Middle mesial scouting!!

They are challenging always, tough to locate and debride most of the times. Specially when you are working on older patients, they pose a great challenge since the lumen is narrow and tend to put of large amount of stress on your shaping instruments.

One Theory states that, root canal configuration changes and matures after the completion of root development and closure of the apical foramen. Furthermore, the continuous deposition of secondary dentin occurs within the root canals, leading to a more complicated root canal configuration and the possibility of developing a third root canal in the mesial root of the first and second mandibular molars.

Tough to Trough!! Middle mesial canal scouting.

Keep scouting, cheers!!

27/07/2025

Curvatures, calcification, splits all in one!!

One of the toughest case in recent times, tested patience to the core.

Extremely narrow canals with a deep seated split with distal canal scouted and filled. Multiplaner curvatures with mesial system.

Hybrid approach using Reciprocation.

Cheers, keep scouting.

21/07/2025

Finding mb2 is always a challenge, and to negotiate the path that has a completely independent trajectory would add onto the complexity of the case.

An independent MB2 canal means it has its own distinct opening (or***ce) in the pulp chamber and travels to the apex as a separate entity. Although it may have an anastomosis joining mb1 somewhere in the middle, but again finding a separate path further.

This contrasts with canals that may join with the primary MB1 canal (confluent) or have a joining and separate exit (fin). Scouting such anatomies with hand instruments is a task in narrow Calcified canals.

Here is a case with independent mb2 , with multiple transverse ramifications in between and opening laterally along the inner wall.
Keep scouting, cheers

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