Successful Root Canal Treatment on Tooth 47 with Severe Curvatures Using EZ Shaper Pro – Advanced Endodontic Case

Dr. Adham Farroukh – Syria

Tooth: #47
Diagnosis: Symptomatic Irreversible Pulpitis
Case Difficulty: Advanced Case

Case Overview

This advanced endodontic case involved Tooth 47 diagnosed with symptomatic irreversible pulpitis. The mesial canals were severely constricted with extreme curvatures, presenting a significant challenge in achieving patency and managing the high risk of apical blockage.

The patient reported persistent pain, and the case required careful, methodical instrumentation to avoid complications commonly associated with severely curved and constricted canals.

Clinical Challenges

• Severely constricted mesial canals
• Extreme curvatures increasing the risk of procedural errors
• Persistent apical blockage during initial negotiation
• Need for delicate handling to achieve and maintain patency

In such complex cases, excessive enlargement is not recommended. Instead, adequate time must be allocated for both canal preparation and thorough irrigation.

Clinical Workflow & Treatment Steps

1. Removal of Previous Restoration
   The old restoration was completely removed to allow proper access.
2. Coronal Preflaring
   Coronal preflaring was performed using EZ Shaper Pro (EZx) files.
3. Scouting & Patency Achievement
   Manual scouting was carried out with pre-curved hand files up to size 15. When apical blockage was encountered, patency was carefully searched for after appropriate pre-curving of both manual and rotary files.
4. Final Canal Preparation
   Final shaping of the canals was safely completed using EZ Shaper Pro (EZ2) files. Due to the extreme curvatures, enlargement was kept conservative.
5. Obturation
   Final obturation was performed using the single cone technique with bioceramic sealer.

Clinical Tips for Managing Severely Curved Canals

• Pre-curve is Key: When apical blockage is encountered without achieving patency, it is essential to carefully search for patency after appropriate pre-curving of both manual and rotary files.
• Less is More: Excessive enlargement is not recommended in cases with extremely severe curvatures.
• Take Your Time: Do not rush in such challenging cases. Allocate adequate time for both canal preparation and irrigation to ensure safety and success.

Doctor’s Feedback on EZ Shaper Pro

“It’s the first time to use it… It was amazing!”

Dr. Adham Farroukh expressed high satisfaction with the performance of the EZ Shaper Pro file system in this demanding case, particularly noting its effectiveness in navigating severely constricted and extremely curved mesial canals of tooth 47.

Conclusion

This advanced endodontic case demonstrates the importance of proper technique, patience, and the right instrumentation when treating teeth with symptomatic irreversible pulpitis and complex root canal anatomy. The combination of careful scouting, pre-curved files, conservative shaping with EZ Shaper Pro, and single-cone obturation with bioceramic sealer led to a successful outcome.