Impact of Multiple Individualized Guides on the Management of Obliterated Root Canals in a Maxillary First Molar: A Case Report

This report evaluated the impact of using multiple individualized endodontic access guides in the management of obliterated root canals in maxillary molars. A 70-year-old female patient presented with pain in the upper left first molar. Intraoral examination revealed an extensive resin composite restoration, with no signs of tooth mobility or marginal periodontal disease. The clinical diagnosis was symptomatic apical periodontitis. Cone beam computed tomography (CBCT) revealed a hypodense area in the mesiobuccal and palatal (P) roots, associated with signs of apical periodontitis and obliterations in the cervical and middle thirds of the first MB (MB1), second MB (MB2) and P canals. Due to the high risk of perforation, a guided approach to the canals was selected. Multiple guides were designed using digital planning software, combining CBCT images with intraoral scanning. Access cavities were created using a 25 mm long, 1.0 mm diameter surgical bur. After gaining access, the canals were instrumented, medicated with calcium hydroxide for 15 days, and obturated. Twelve months post-treatment, the patient remained asymptomatic, and the clinical results were considered satisfactory. (EEJ-2025-01-06).