Endo-Restorography of a Severely Curved Mandibular Third Molar
A biologically driven approach combining endodontic precision and adhesive restoration
Introduction
Mandibular third molars are often excluded from restorative and endodontic planning due to difficult access, unpredictable anatomy, and severe canal curvatures. However, when strategic value, occlusal function, and patient-specific factors justify preservation, a conservative endo-restorative approach can be a predictable alternative to extraction.
This case demonstrates a complete endo-restorography workflow in a severely curved wisdom tooth, emphasizing strict isolation, controlled canal negotiation, and immediate adhesive restoration to restore both biology and biomechanics.
Pre-operative Assessment
Clinical examination revealed a carious mandibular third molar with deep dentinal involvement and symptoms consistent with irreversible pulpitis. Radiographic evaluation showed:
- Severe apical and mid-root curvature
- Narrow, tapering canals
- Intact periapical structures
- Adequate periodontal support
Given the absence of periapical pathology and the strategic importance of the tooth, a conservative endodontic and restorative approach was selected.
Isolation and Access Strategy
Absolute isolation with rubber dam was mandatory due to the posterior location and proximity to soft tissues. Proper isolation ensured:
- Saliva-free operative field
- Prevention of bacterial contamination
- Improved visibility and control
Access cavity preparation was performed conservatively, respecting pericervical dentin and maintaining a straight-line path without over-flaring, which is critical in curved third molars.
Canal Negotiation and Shaping
Severely curved canals demand a biological rather than aggressive shaping philosophy.
Key principles applied:
- Initial scouting with small, pre-curved stainless steel hand files
- Gentle watch-winding and balanced force motions
- Glide path establishment before any rotary instrumentation
- Continuous irrigation and recapitulation to prevent blockage and ledging
Rotary instrumentation was used minimally and only after a secure glide path was confirmed, avoiding transportation and preserving canal anatomy.
Working Length and Irrigation
Working length was established using an electronic apex locator and radiographic confirmation.
Irrigation protocol focused on safety and efficacy:
- Sodium hypochlorite for organic tissue dissolution
- Activation through manual agitation
- Avoidance of excessive apical pressure due to curvature and apical anatomy
The goal was disinfection without compromising apical integrity.
Obturation Strategy
Obturation was performed using a technique adapted to curved canals, prioritizing:
- Apical control
- Homogeneous filling without forcing material
- Respect for original canal curvature
The obturation endpoint showed dense filling following the natural anatomy, without apical extrusion or voids.
Endo-Restorography Concept
Endodontic success does not end with obturation. Immediate restoration is a biological requirement, not a cosmetic step.
After obturation:
- Chamber was cleaned and sealed
- Adhesive protocol was initiated under rubber dam
- No delay was allowed between endodontics and restoration
This immediate transition from endo to restoration minimizes coronal leakage and bacterial re-entry.
Adhesive Restoration
A direct adhesive restoration was placed following biomimetic principles:
- Conservative cavity design
- Stress-reduced incremental composite placement
- Preservation of cuspal integrity
- Re-establishment of occlusal anatomy
The restoration was designed to reinforce the tooth structure rather than simply fill space, transforming the treated tooth into a functionally integrated unit.
Post-operative Evaluation
Radiographic and clinical evaluation confirmed:
- Adequate obturation following severe curvature
- Proper coronal seal
- Functional occlusion
- Absence of immediate post-operative symptoms
The tooth was returned to function with preserved biology and structure.
Discussion
Third molars are often extracted by default. However, this case highlights that with:
- Proper case selection
- Respect for anatomy
- Controlled endodontic techniques
- Immediate adhesive sealing
Even severely curved wisdom teeth can be treated predictably.
Endo-restorography bridges the gap between endodontics and restorative dentistry, emphasizing that long-term success depends on both disciplines working as one.
Conclusion
This case reinforces that endodontic treatment of curved wisdom teeth is not about technical bravado but about biological respect and restorative foresight. When performed under isolation, magnification, and a biomimetic mindset, endo-restorography allows preservation of teeth that would otherwise be sacrificed.
References
- Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol. 1984.
- Peters OA. Current challenges and concepts in the preparation of root canal systems. Int Endod J. 2004.
- Clark D, Khademi J. Modern molar endodontic access and directed dentin conservation. Dent Clin North Am. 2010.
- Magne P, Belser U. Bonded porcelain restorations in the anterior dentition. Quintessence.
- Rocca GT, Krejci I. Bonded indirect restorations for posterior teeth. J Adhes Dent. 2015.
- Saunders WP, Saunders EM. Coronal leakage as a cause of failure in root canal therapy. Endod Dent Traumatol.
{"source_type":"hypic","data":{"infoStickerId":"","pictureId":"CBC66A6E-86AC-4F9F-BAC8-F40F417AFA11","product":"retouch","imageEffectId":"","playId":"","activityName":"","appversion":"7.9.0","filterId":"","os":"ios","enter_from":"enter_launch","stickerId":""},"tiktok_developers_3p_anchor_params":"{"filter_id":[],"capability_extra_v2":{"edit":[{"panel":"hd_quality_picture"}]},"capability_key":["edit"],"template_id":"","client_key":"awgvo7gzpeas2ho6"}"}
{"source_type":"hypic","tiktok_developers_3p_anchor_params":"{"capability_extra_v2":{"edit":[{"panel":"hd_quality_picture"}]},"template_id":"","capability_key":["edit"],"filter_id":[],"client_key":"awgvo7gzpeas2ho6"}","data":{"imageEffectId":"","os":"ios","enter_from":"enter_launch","appversion":"7.9.0","infoStickerId":"","product":"retouch","activityName":"","playId":"","stickerId":"","pictureId":"5FBC1502-DFCC-4B88-B7D5-BA634397CE3A","filterId":""}}
{"data":{"filterId":"","enter_from":"enter_launch","product":"retouch","playId":"","os":"ios","infoStickerId":"","imageEffectId":"","pictureId":"86066D3A-A5EF-427E-BBF9-9B39861FE7BD","appversion":"7.9.0","stickerId":"","activityName":""},"source_type":"hypic","tiktok_developers_3p_anchor_params":"{"client_key":"awgvo7gzpeas2ho6","template_id":"","filter_id":[],"capability_extra_v2":{"edit":[{"panel":"hd_quality_picture"},{"panel":"one_key_edit"}]},"capability_key":["edit"]}"}
{"source_type":"hypic","tiktok_developers_3p_anchor_params":"{"capability_key":["edit"],"filter_id":[],"capability_extra_v2":{"edit":[{"panel":"hd_quality_picture"},{"panel":"one_key_edit"}]},"template_id":"","client_key":"awgvo7gzpeas2ho6"}","data":{"os":"ios","enter_from":"enter_launch","stickerId":"","product":"retouch","filterId":"","imageEffectId":"","appversion":"7.9.0","activityName":"","infoStickerId":"","playId":"","pictureId":"516BFD7B-944F-46E7-81D7-2E7F057C5A3D"}}
Share on:
