11 July 2024

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Navigating the Endodontic Challenge of a 40 mm Canine and Its Technical Adaptations

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Aim

The aim of this case report is to present the successful endodontic management of an abnormally long right maxillary canine diagnosed with symptomatic irreversible pulpitis, highlighting the technical adaptations employed during treatment.

Summary

Technical adaptations included modifying the handle of the endodontic hand file and utilizing a side-vented microcannula for irrigation using positive and negative pressure technique. Despite the challenges posed by the abnormal tooth length, the procedure achieved a working length of 40.7 mm, and periapical radiography confirmed the master gutta-percha reaching full working length. Notably, the patient remained asymptomatic during the six-month follow-up, highlighting the efficacy of the treatment. This article also reviews the current literature, examining comparable cases and techniques documented in scholarly sources.

Introduction

Understanding the anatomy of the root canal system and its morphological variations is crucial for the success of every step of endodontic treatment. Comprehensive knowledge of the intricate details of the root canal’s anatomy enables clinicians to employ the most suitable treatment techniques and protocols, ultimately enhancing the overall success rate of the procedure. The complex nature of canal systems poses new challenges, underscoring the importance of thorough disinfection. Effective disinfection is particularly vital because any debris that remains adhered to canal walls after mechanical instrumentation can compromise the cleaning process, leading to potential treatment failures.

Achieving proper instrumentation of the root canals and ensuring complete debridement are key objectives in endodontic procedures. However, a notable challenge arises in the case of long canals, where reaching the total length of the tooth can be difficult. Uncommonly encountered, extremely long teeth, also referred to as radiculomegaly, have rarely been documented in the literature, posing a distinctive challenge in achieving thorough mechanical cleaning of the root canal. The canine, particularly the maxillary canine, is the most commonly affected tooth in this context, with a typical average length of 27.3 mm.

Several studies have documented the extraction of maxillary canines with exceptionally long roots, reaching up to 52 mm in length. Moreover, various studies have investigated the root canal treatment procedure and necessary modifications for such lengthy roots. Given the inherent difficulty in performing endodontic procedures and cleaning the entire root length, compounded by the unavailability of commercially produced endodontic instruments longer than 31 mm, our case report is aimed at detailing the biomechanical preparation and obturation of an unusually long maxillary canine measuring 40.79 mm. In this report, we seek to explore and discuss the treatment modifications essential for the successful management of these exceedingly rare cases.

Authors: Siavash Moushekhian, Pooya Saeedi, Zoha Sahebnasagh

Source: https://onlinelibrary.wiley.com/