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Case Reports
. 2022 May 16;10(14):4632-4639.
doi: 10.12998/wjcc.v10.i14.4632.

Successful individualized endodontic treatment of severely curved root canals in a mandibular second molar: A case report

Lai-Jun Xu  1 , Jian-Ying Zhang  1 , Zi-Hua Huang  1 , Xiang-Zhu Wang  2
Affiliations
Case Reports

Successful individualized endodontic treatment of severely curved root canals in a mandibular second molar: A case report

Lai-Jun Xu et al. World J Clin Cases. .

Abstract

Background: The incidence rate of severely curved root canals in mandibular molars is low, and the root canal treatment of mandibular molars with this aberrant canal anatomy may be technically challenging.

Case summary: A 26-year-old Chinese female patient presented with intermittent and occlusal pain in the left mandibular second molar. The patient had undergone filling restoration for caries before endodontic consultation. With the aid of cone beam computed tomography (CBCT), a large periapical radiolucency was observed, and curved root canals in a mandibular second molar were confirmed, depicting a severe and curved distolingual root. Nonsurgical treatments, including novel individualized preparation skills and techniques and the use of bioceramic materials as an apical barrier, were performed, and complete healing of the periapical lesion and a satisfactory effect were achieved.

Conclusion: A case of severely curved root canals in a mandibular second molar was successfully treated and are reported herein. The complex anatomy of the tooth and the postoperative effect were also evaluated via the three-dimensional reconstruction of CBCT images, which accurately identified the aberrant canal morphology. New devices and biomaterial applications combined with novel synthesis techniques can increase the success rate of intractable endodontic treatment.

Keywords: Canal curvature; Case report; Cone beam computed tomography; Mandibular second molar; Root canal therapy.

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Conflict of interest statement

Conflict-of-interest statement: The authors declare that they have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
Initial clinical situation (#37). A: Photograph of the mandibular second molar; B: Preoperative periapical radiograph of the molar; C: Measurement of the radius of the curvature and angles; D and E: Sagittal (D) and coronal (E) dimensions obtained from cone beam computed tomography (CBCT); F-H: Axial dimensions obtained from CBCT; I: Three-dimensional reconstruction of CBCT images presenting the perforation of the lingual cortical plate. White and yellow arrows represent the mesial root canals and a distal root canal, respectively; orange arrows show the regions of large periapical radiolucency.
Figure 2
Figure 2
Treatment of the mandibular second molar. A: Severe curvature of the file in the canal apex; B: Preoperative image; C: Postoperative image of the bottom medullary chamber; D: Radiograph for working length determination; E: Final radiograph after the operation; F: Follow-up at 2 wk; G: The tooth after crown preparation; H: Ceramic crown; I: Occlusal surface after restoration.
Figure 3
Figure 3
Post-treatment situation of the mandibular second molar and follow-ups. A: Occlusive situation of the left molars; B and C: Three-month (B) and one-year (C) radiographic follow-up images demonstrating healing of the periapical lesion; D-H: Cone beam computed tomography (CBCT) images at 1-year radiographic follow-up; I: Three-dimensional reconstruction of CBCT images presenting healing of the lingual cortical plate. White and yellow arrows represent the mesial root canals and a distal root canal, respectively; orange arrows show the regions of periapical healing.
See this image and copyright information in PMC

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