CASE #1 – 2019

We are all asked to endodontically treat mandibular molars. As we decide to accept this challenge, I have found that apical arborization exists extensively within canal anatomy variations. This is most likely not new information to more experienced clinicians, yet a daily clinical awareness of root end anastomoses does allow for a greater percentage of predictable, and ultimately successful results for our patients. Now this does NOT exclude anatomic variation presenting in any other root end in the human dentition.

Lord knows apical variation exists wherever it wants to.

Yet this post focuses on the distal root of mandibular molars.

Being a clinical endodontists with 37 years of experience and producer of “Success in Endodontics” I still get excited with the “Thrill of the Fill “ moments as they present in my daily practice.

Case #1 Extensive loss of osseous tissue.

AXIAL VIEW
CORONAL VIEW
INTAKE RADIOGRAPH
WORKING RADIOGRAPH
FINAL RADIOGRAPH

Yes, this patient was advised to have #18 reevaluated as we strongly suspected and informed them of probable endodontic treatment for #18.

Case #2 Apparent mesial curvature to distal root end.

INTAKE RADIOGRAPH 2
CHECK RADIOGRAPH 2
FINAL RADIOGRAPH 2

This patient was referred back to their general dentist for the necessary restorative work.

Case #3 Challenging negotiation of distal root end.

INTAKE RADIOGRAPH 3
CHECK RADIOGRAPH 3
FINAL RADIOGRAPH 3

I posted this third case, as a cursory radiographic appraisal of the distal canal appeared straightforward; it was difficult to negotiate as seen in the check image. After completion of our obturation protocol we where able to clinically achieve a nice result.

Clinical endodontics remains a daily challenge for all of us. I would appreciate a discussion below of how you individually like to deal with these foreseeable complications of our chosen profession.

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