The Case:

Tooth #3 was recently prepared for a crown, and the dentist had exposed the nerve. He was in no pain,
and was diagnosed with a symptomatic irreversible pulpitis. I was immediately concerned about the
curvature on the MB root, and my CBCT showed there were four total canals and very long roots.
1. I opened the tooth and located the four canals, but I was having difficulty getting down the MB root. I used
pre-curved #.06 C-Files to slowly get down millimeter by millimeter, then confirmed radiographically when
I made it to the apex.
2. From there, I slowly instrumented by hand up-to an .08 and a .10 K-File. And because of the severe
curvature, I instrumented with a #12.5 C-File to length.
3. At this point I was comfortable with the glide path I had created, so I instrumented the canals to length
with the Traverse Glide Path 13/.06 file, followed by the Traverse 18/.06.
4. The canals ranged from 21 mm to 24 mm.
5. I then used the ZenFlex 25/.04, 30/.04, 35/.04, and 40/.04.
6. I finished the mesial canals with the 25/.04, the distal on the 30/.04. the palatal was wider so I finished
with the 40/.04.
7. After irrigation, I obturated using the elements IC system with corresponding ZenFlex gutta percha points
and a resin-based sealer, which made a difficult case easy to finish!

Dr. Meredith Newman is a paid consultant of Kerr. The opinions expressed in this article are those of Dr. Newman. Kerr is a medical device manufacture and does not dispense medical advice. Clinicians should use their own professional judgment in treating their patients.

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