Clinical case: Complex treatment on a 25 with tight double curvature

Presentation by Dr. David Azaria

Dr David Azaria , graduated in dental surgery from the University of Paris V in 2015. He works in private practice in Boulogne-Billancourt (92) and shares his expertise as an instructor for Endo Académie.

Passionate about endodontics, he is also an active member of the French Society of Endodontics (SFE) and graduated from the DESU in Endodontics from the Aix-Marseille faculty in 2022.

Presentation of the clinical case

A 35-year-old patient in great shape was referred for endodontic treatment at the age of 25 following the accidental discovery of a periapical lesion of endodontic origin (LIPOE). The diagnosis? Totally inadequate initial treatment, an infiltrated composite filling, and to top it all off: a tight double curve, just to gently complicate our lives.

Preoperative radiographic analysis

Preoperatively, the X-ray shows a tooth whose treatment is more symbolic than effective: the filling is short, the composite lets bacteria through like a sieve, and the double curve with a small radius announces a major challenge. The root anatomy looks more like a roller coaster loop than a smooth straight line.

Post-operative radiographic analysis

The postoperative X-ray shows that the canal space is filled with a bioceramic seal. Although the gutta cones did not reach their working length due to curvatures, the use of MTA NeoSealer ensures a hermetic obturation, compensating for this with its exceptional fluidity.

The result is clean, dense, with a closure of the "exit door" which suggests good healing. The prognosis remains cautious, with clinical and radiographic monitoring at one year.

The products used for this clinical case

For this case, Dr. Azaria used:

• Main shaping system: Zarc's Excalibur – ideal for negotiating double bends without fear of fracture, thanks to its reciprocal movement and robustness.

• Complementary system: Kerr K-Flex hand files – the ally of large, tight curves to slowly but surely gain apical progression.

• Obturation technique: Avalon MTA NeoSealer – a bioceramic cement that flows perfectly into the smallest corners, even when gutta cones cannot cover everything.