Severe Curved Root Canal Treatment In Upper Right Posterior Tooth

Root canal treatment was undertaken following the failure of indirect pulp capping in the first molar. The treatment challenge lies in the preparation of severely curved root canals. A 21-year-old female patient presented with spontaneous and biting pain in the upper right first molar (tooth #16), which had undergone indirect pulp capping 1.5 years prior. Clinical examination revealed a resin restoration without percussion pain, mobility, or sinus tract formation. Radiograph showed a high-density lesion involving the pulp tissue and a widened periodontal ligament space at the mesial root apex, with an 80° curvature in the mesial root canal (measured using the Schneider method). Diagnosis: Apical periodontitis with curved root canals. Treatment: Under microscope and rubber dam isolation, canals were slowly negotiated using #8 and #10 C-files with 17% EDTA gel. The mesiobuccal canal was managed with pre-curved C-files and short-amplitude strokes to avoid ledging. Pathfile NiTi instruments (Dentsply) were used to size #19, followed by Mtwo NiTi files (VDW) for shaping. Obturation was performed with warm vertical compaction, and the crown was restored with composite resin. Subsequent full crown restoration is recommended. The balanced force technique and effective removal of dentine debris are critical to avoid ledging during instrumentation. Additionally, fatigue management of NiTi instruments is essential. Strategic negotiation of calcified areas and proper fatigue control of NiTi instruments are fundamental to the successful preparation of curved root canals, adhering to biomechanical principles to minimize complications.