Complex root canal anatomy

In the December article “Challenge accepted: Preparation for root canal curvature” in the renowned ZWP magazine, Dr. Christofzik gives us a detailed insight into a particularly challenging root canal treatment.

The patient, a 40-year-old woman, was sent to Dr. Christofzik by a referrer after treatment had been started on tooth 47. The referrer had trephined correctly and found the mesiobuccal, mesiolingual and distal canals, but was unable to successfully prepare the lower, severely curved third.

The patient visited Dr. Christofzik’s practice one day later complaining of highly acute pain caused by inflamed nerve tissue in the apical third. This was the start of a complex challenge that required an innovative approach.

In the initial phase of consideration, Dr. Christofzik identified the need for heat-treated files, in particular the FQ system from Komet Dental, as indispensable for the indication at hand. These special instruments ensure the necessary flexibility, especially in areas with large radii of curvature, and thus promise significant advantages in root canal preparation.

The professional endometry of the EndoPilot, the use of the heat-treated FQ files and the successful obturation with KometBioSeal proved to be decisive in overcoming this challenging case. The choice of the FQ system was based on very fine file diameters. The multifunctional use of the EndoPilot, as an apex locator in real time with stop function and for three-dimensional obturation, proved to be a comprehensive and safe solution for this challenging situation.

Dr. Christofzik decided against the traditional DownPack and BackFill method with warm vertical condensation technology, as this was unsuitable for this particular case. The long curvatures in the apical third required a different solution. The hydraulic, bioceramic root canal filling with KometBioSeal was used here.

Using a delicate syringe, Dr. Christofzik injected KometBioSeal two-thirds of the way into the canal system and then used a suitable master point to generate the hydraulic pressure required for even distribution right up to the tip. Careful compaction of the gutta-percha after melting with plugs ensured perfect closure of the canal system. The gutta-percha was separated cleanly and efficiently with the heating tip of the Down Pack, a possible extension of the EndoPilot. This technique proved to be simpler and more reliable than conventional heating over a flame.