ROEN0110

28 I I case report _ maxillary molars _Maxillary first molars are notable for their complex root- canal system morphology. The mesio-buccal (MB) roots are characterised by an irregular ovoid morphology, resulting in an isthmus or fin of pulpal tis- sue extending palatally to the principle MB canal. This case report presents steps taken to address this anatomy in order to maximise the disinfection and debridement of the root- canalsystem.Failuretoaddress this anatomic complexity may lead to persistence or recur- rence of endodontic disease. _Endodontic evaluation A58-year-oldfemalepatientpresented for endodontic evaluation and therapy in the upper left quadrant. Mild pain for several days was reported by the patient prior to the appointment. Medical history was non-contributory, and dental history was remarkable for multiple existing large amalgam restorations (Figs. 1–3). Clinical examination and diagnostic evaluation were performed for all posterior teeth on the right side, including cold testing, percussion,palpation,periodontalprobing and bite challenge. Findings led to a pre- operative diagnosis of irreversible pulpitis in tooth #3 with normal peri-radicular tissues. After anaesthesia and isolation with the rubber dam, entry was made into a calcified pulp chamber. Use of the dental operating microscope (OM) greatly en- hances lighting and visibility, allowing for careful and de- liberate clearing of reparative dentine, pulp stones and other potential impediments to canal orifices.Itisimportanttostress that the files must not be taken intothecanalspriortodevelop- ing proper access form. In such cases, ledging and blockages can easily occur, needlessly compromising and complicat- ing treatment. The palatal pulp tissue was calcified and extir- pated intoto(Fig. 4). roots1_2010 Managing maxillary molars Author_ Dr Mark Dreyer, USA Fig. 1 Fig. 2 Fig. 3