Endodontic treatment of a 36-mm long upper cuspid: clinical case report

Abstract

Purpose: To report a clinical case of a 36 mm long upper cuspid submitted to root canal treatment, with emphasis on the alternative technique employed.Case description: A 32 years old, male patient had suffered subluxation of teeth 12 and 13 and coronal fracture involving enamel and dentin, as well as pulp exposition, of tooth 14 because of a motorcycle accident. The man was given dental assistance and a semi-rigid splinting of teeth numbers 12 and 13 was carried out followed by the root canal treatment in a single visit on tooth no. 14. At 30-day follow-up pulp necrosis was detected in teeth 12 and 13 and the root canal treatment was implemented. The tooth 13 was 36 mm long and since the longest possible file (31 mm) was already in use, the cervical limit of the access cavity was considered as the reference point.Conclusion: This technique not only provided adequate disinfection, preparation and filling of the root canal, but it also allowed preservation of the remaining tooth structure.Key words: Anatomy; cuspid; dental pulp cavity; endodontics ResumoObjetivo: Descrever o tratamento endodôntico de um canino superior medindo 36 mm de comprimento, mostrando a técnica empregada no preparo do canal radicular e obturação.Descrição do Caso: Paciente do sexo masculino, com 32 anos de idade, sofreu subluxação dos dentes 12 e 13 e fratura coronária envolvendo esmalte e dentina, com exposição pulpar do dente 14, devido a um acidente de moto. No atendimento de urgência, foi realizada a contenção semirrígida dos dentes 12 e 13, seguida da endodontia em sessão única do dente 14. Trinta dias após, foi diagnosticada necrose pulpar dos dentes 12 e 13 e sua endodontia foi, então, iniciada. O comprimento aparente do dente 13 foi estabelecido em 36 mm e como o instrumento mais longo que dipomos no mercado possui 31 mm, o limite cervical da cavidade de acesso foi usado como bordo de referência.Conclusão: Além de garantir uma correta sanificação, modelagem e obturação do canal, esta técnica também permitiu a preservação da estrutura dental remanescente.

Technical adaptations of manual and rotary instruments for preparing a giant canine tooth

“…Few studies about root canal treatment of long teeth are reported in the literature, ranging from 32 to 42 mm of WL (Al-Dahman et al, 2017;Barletta et al, 2010;Bellizzi, 1982;Booth, 1988;Cardoso et al, 2019;Hussain & Awooda, 2020;Maden et al, 2010;Vargo & Hartwell, 1992;Venokur & Fink, 1976;Zmener, 2003). However, some authors revealed the existence of extremely long teeth, with maxillary canines ranging from 41 to 52 mm (Booth, 1988;Hayward, 1980;Marashi & Gorlin, 1990;Wilkie & Chambers, 1990).…”

“…Regarding the strategies of treating long teeth, four strategies were found in order to compensate the limitations of the endodontic instruments: endodontic instrument adaptation (Bellizzi, 1982;Cardoso et al, 2019;Hussain & Awooda, 2020), changing the reference edge of the endodontic instrument (Al-Dahman et al, 2017;Barletta et al, 2010;Vargo & Hartwell, 1992), wearing the crown by drill in order to reach the ideal WL, and using veterinary files.…”

“…According the authors, the hand files are grasped by a tweezer in an inverted pen grasp and the canal is biomechanically prepared by push-pull movement. Barletta et al (2010) described an endodontic treatment of a maxillary canine measuring 36 mm. The authors changed the reference point of the endodontic instrument from incisal to cervical limit.…”

“…Treatment of dental anomalies is a potential endodontic challenge (Barletta, Grecca, Wagner, Ferreira, & Lopez, 2010). Radiculomegaly is an anomaly that the teeth have extremely large roots, and it may be isolated (Al-Obaida, 2020;Wilkie & Chambers, 1990) or correlated with other pathologies (Gorlin, Marashi, & Obwegeser, 1996;Marashi & Gorlin, 1990;.…”

“…Extraordinary length of the tooth complicates endodontic procedures due to the difficult of cleaning all root length (Barletta et al, 2010), because there are no endodontic instruments longer than 31 mm commercially available. Few studies and have investigated the root canal treatment of long teeth (Al-Dahman, Al-Hawwas, & Al-Jebaly, 2017; Barletta et al, 2010;Bellizzi, 1982;Booth, 1988;Cardoso et al, 2019;Hussain & Awooda, 2020;Maden, Savgat, & Görgül, 2010;Vargo & Hartwell, 1992;Venokur & Fink, 1976;Zmener, 2003). Thus, this study presents technical report of root preparation of a long maxillary canine with 39.59 mm of length, with adaptations techniques that can be used to deal with these cases.…”