Endodontic treatment of mandibular molar with root dilaceration using Reciproc single-file system
The patient, a 22-year old man, complaining of moderate pain in tooth #47 upon chewing, was referred to the Dental Clinic of the Federal University of Amazonas, Brazil. The patient did not have any systemic diseases and were not under any type of medication or drugs. Intraoral examination revealed the presence of a temporary restoration. The tooth was tested for pulp sensibility with Endo Frost spray (Roeko GmbH & Co., Langenau, Germany) and responded positively to the cold test, and negatively to the mobility test. The periapical radiographic examination revealed that the temporary restoration was extremely deep, since the tooth had already been submitted to pulpotomy procedure. Moreover, an accentuated dilaceration in the mesial root, a developmental anomaly characterized by an abrupt change in the axial inclination of the root, was observed. Also, no periapical lesions were observed ().\nThe tooth was diagnosed as asymptomatic irreversible pulpitis and endodontic treatment was instituted. After local anesthesia (Xylestesin 2%, Cristália Produtos Químicos Farmacêuticos Ltda., Itapira, SP, Brazil) and rubber dam isolation (Hygienic, Coltene/Whaledent AG, Alstatten, Switzerland) of the operative area, the temporary restoration was removed and pulp chamber access procedure using spherical burs No. 1013 (KG Sorensen, São Paulo, SP, Brazil) and tapered flame shaped burs No. 2200 (KG Sorensen) was performed. Next, the root canals orifices were located with the aid of a straight exploratory probe. The glide path was performed using #10 K-files (Dentsply Maillefer, Ballaigues, Switzerland) and Pathfile #13, #16 and #19 (Dentsply Maillefer) up the working length of 18 mm.\nBiomechanical preparation of the cervical and middle thirds was performed using the Reciproc system (VDW GmbH, Munich, Germany) coupled to the electric motor Silver Reciproc VDW handpiece (Sirona Dental Systems GmbH, Bensheim, Germany) with 6 : 1 reduction in the Reciproc ALL mode and a R25 file with 0.08 taper. When the cervical and middle thirds were finalized, the working length was measured with the aid of an electronic apex locator (Joypex 5, Denjoy Dental Co., Ltd., Changsha, China), which revealed that the real working length was 20 mm in the mesio-buccal and mesio-lingual canals, and 22 mm in the distal canal. To finalize and refine apical preparation, the R25 file of the Reciproc system was used again in the real working length. At each change of instrument, the canals were irrigated with 2.5 mL of 2.5% Sodium Hypochlorite solution (Biodinâmica, Ibiporã, PR, Brazil) using a disposable syringe and NaviTip needle (Ultradent, South Jordan, UT, USA). After complete instrumentation, 17% ethylenediaminetetraacetic acid (EDTA, Biodinâmica, Ibiporã, PR, Brasil) was used for smear layer removal. The canals were dried with absorbent paper points R5 (VDW GmbH) and filled using gutta-percha cones R25 (VDW GmbH) and AH Plus sealer (Dentsply Maillefer), by thermal compaction technique using McSpadden #50 (Dentsply Maillefer).\nNext, the pulp chamber was cleaned to remove the excess of gutta-percha and sealer. Glass-ionomer restorative cement (Vidrion R, SS White, Rio de Janeiro, RJ, Brazil) was used as temporary restoration due to its good sealing ability and fluoride release. After 2 weeks, the tooth was definitely restored with composite resin (Z250, 3M ESPE, Sumaré, SP, Brazil) (). Continued follow-up over 6 months has shown a successful outcome from endodontic perspective (). Clinically, the tooth presented no painful symptomatology, and radiographically, no signs of failure in root canal filling or periapical lesions were observed.