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<< Back to 2004 Case List

September 2004 – Endo on a Curvy Mandibular Wisdom Tooth

Fig. 1

A 28 year old female patient presented with a history of recent endodontic access and limited oral opening. What's more this wisdom tooth was in function and had good occlusion. She elected for treatment and restoration rather than extraction. Fig.1 shows the referrals pre-op film.

Fig. 2

Fig. 2 is my digital x ray image that showed some very heavy apical curvatures that are caused by the eruption pattern of the tooth. Many wisdom teeth initially erupt horizontally and then move vertically into their final position. This can contribute to some very difficult apical curvatures.

Fig. 3

Fig. 3 shows the working length films. My assistant had a lot of difficulty obtaining the image because of the patient's limited opening combined with the posterior position of the tooth and limitations of the rubber dam and clamp. An electronic apex locator indicated that I was at the terminus but I had some suspicions that the canals also were turned slightly buccally ( out of the plane of the screen toward you.)

The canals were cleaned and shaped using the traditional serial hand filing and hand reaming technique, mostly because of the difficulty of getting the head of a rotary Ni-Ti handpiece into position. Once I had a #15 file to the terminus, I did use the ProTaper SX to open the orifices slightly and allow greater access to the midroot. The canals were obturated using .06 taper AutoFit Ker Gutta Percha Cones/Kerr Sealer and standard Vertical compaction of Warm Gutta Percha technique. (Fig.4)

Fig. 4

Conclusion
This was a very challenging case. In some extreme cases, rotary engine driven instrumentation is not be possible or even desirable. Knowing how to use hand instruments first and foremost allows for treatment in cases where patient opening is limited and where risk of rotary file breakage is high. This case took quite a while to do but the results are very gratifying. Such curvatures can be negotiated with careful pre-bending and re-bending of instruments, heavy irrigation and frequent patency checks. The distal canal could have had a bit more shape in the mid-root but all things considered, I was pretty happy with the results.