Multirooted teeth represent a challenge to both endodontic diagnosis and treatment due to its complex and unusual root canal morphology in many cases and often encountered during endodontic treatment. Success depends on understanding the unusual root canal morphology. One of the variant root canal morphology is the &lsquo;S&rsquo; shaped or bayonet shaped root canal. This case report discusses the endodontic management &nbsp;of &lsquo;S&rsquo; shaped root canal in maxillary first premolar

Niladri Maiti

Sayantan Mukherjee

Utpal Kumar Das

English

eDENT Journals

Managing the Risky Curve – A Case Report 
 
Utpal Kumar Das¹, Sayantan Mukherjee,2 Niladri Maiti3 
 
 
 
  
 
 
 
 
 
 
Introduction   
 
Root anatomy is highly complex and unpredictable. The knowledge of the 
normal and its frequent variations can greatly enhance the success rate of endodontic 
practice. Variations in the number and the configuration of the root canals is not 
uncommon [1]. 
Routine periapical radiographs helps us to assess the number, length, 
curvature and aberration of the canal system of the tooth. Root canal curvatures can 
be apical curve, gradual curve, sickle-shape curve, severe-moderate-straight curve, 
bayonet curve, dilacerated curve [2,3]. 
Curved root canals exhibit great difficulty in cleaning, shaping & obturation of the root 
canal system, therefore determining the degree of curvature of root canal before 
starting the endodontic treatment is mandatory.  
Maxillary premolars are the teeth with the maximum anatomic variations. One 
such variation that occurs often in the maxillary premolars is the ‘S’ shaped or bayonet 
shaped root canal [4,5].S- Shaped canals are also found in maxillary lateral incisors, 
maxillary canines, mandibular molars. S-Shaped or Bayonet shaped canals can be 
troublesome and challenging since they involve atleast two curves, with the apical 
curve being the most vulnerable to deviations in anatomy and loss of working length.  
 
CASE REPORT 
 
A 28 year-old male patient, reported to the Department of Conservative 
Dentistry and Endodontics  with the  chief complaint of pain in upper left tooth region 
since 15 days. 
On clinical examination, left maxillary first premolar had a deep carious lesion 
on the disto-proximal aspect.The tooth was tender on percussion. Radiographic 
examination of the tooth revealed radiolucency in the disto-proximal aspect,with pulp 
exposure. The roots of the tooth  were ‘S’ shaped. (Fig.no.1) 
On the basis of clinical and radiographic findings, a diagnosis of pulp necrosis was 
made and endodontic treatment was initiated. 
 
 
   IJCDS • NOVEMBER, 2013 • 4(2) © 2013  Int. Journal of Clinical Dental Science 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
ABOUT THE AUTHORS 
 
 
1. Prof. (Dr.) Utpal Kumar Das   
                                            MDS, 
 
HOD,  
Department of Conservative 
Dentistry & Endodontics, 
Guru Nanak Institute of Dental 
Science and Research, Kolkata , 
India 
 
2. Dr. Sayantan Mukherjee,
   
                                                                   
MDS  
Reader,  
Department of Conservative 
Dentistry & Endodontics, 
Guru Nanak Institute of Dental 
Science and Research, Kolkata , 
India 
 
 
3. Dr. Niladri Maiti  BDS  
 
Post Graduate Student, 
Department of Conservative 
Dentistry & Endodontics,  
Guru Nanak Institute of Dental 
Science and Research, Kolkata, 
India 
 
 
 
 
 
 
 
 
 
 
Corresponding author -   
 
Dr. Niladri Maiti  BDS  
 
Post Graduate Student, 
Department of Conservative 
Dentistry & Endodontics,  
Guru Nanak Institute of Dental 
Science and Research, Kolkata, 
India 
 
Email: 
drniladrimaiti@gmail.com 
 
 
 
 
 
Abstract      
                         
Multirooted teeth represent a challenge to both endodontic diagnosis and treatment due to its 
complex and unusual root canal morphology in many cases and often encountered during 
endodontic treatment. 
Success depends on understanding the unusual root canal morphology. One of the variant root 
canal morphology is the ‘S’ shaped or bayonet shaped root canal. This case report discusses the 
endodontic management of ‘S’ shaped root canal in maxillary first premolar.  
 
 
Key words: Bayonet shaped canal , NiTi Files, Maxillary First Premolar 
 
 
 
7 
CASE REPORT 
   IJCDS • NOVEMBER, 2013 • 4(2) © 2013  Int. Journal of Clinical Dental Science 
                                                   
 
 
 
 
 
                                               
 
 
 
 
 
 
 
 
 
 
 
 
 
Fig.no.1 Pre-operative IOPAR 
Fig.no.2  Working length determination 
Fig.no.3  Master cone  selection Fig.no.4   Obturation 
Fig no. 5    K flex files 
 
Fig no. 6    Hyflex CM Files 
 
 
8 
   IJCDS • NOVEMBER, 2013 • 4(2) © 2013  Int. Journal of Clinical Dental Science 
On the basis of clinical and radiographic findings, a 
diagnosis of pulp necrosis was made and endodontic 
treatment was initiated. 
 
Clinical Procedure 
 
After administration of anesthesia, the operating 
field was isolated with  rubber dam and access opening 
was done.The access cavity preparation was oval in 
outline, in the bucco-palatal direction. The working 
length (Fig no. 2) radiograph was taken with K Flex Files 
(FKG DENTAIRE,  LOT: 1358)  (Fig.no.5)  
The patency of the root canals was determined 
with help of  ISO  10 size nickel-titanium K-files. The 
chemico-mechanical preparation was done using HYFLEX 
CM file system (Coltene/Whaledent , LOT : MT-149648) 
(Fig no 6). 
Canal irrigation was done using normal saline, 
2.5 % Sodium hypochlorite, and EDTA Liquid (SMEAR 
CLEAR, Sybron Endo), alternately with side vented 
irrigation probe (CANAL CLEAN, BIODENT , KOREA LOT: 
30C101202).  2% Chlorohexidine was used as final rinse. 
After proper cleaning and shaping of the root canals, 
master cone was inserted.(Fig.no.3)Root canals were 
obturated using Roekoseal resin sealer 
(Coltene/Whaledent) ,  
 
Discussion 
 
The variability of the root canal system of 
multirooted teeth represents a challenge to both 
endodontic diagnosis and treatment. The preoperative 
awareness of potential anatomic variations is essential 
for the success of the endodontic treatment. The only 
way to detect root canal morphology and anatomy is the 
use of a preoperative radiograph and an additional 
radiographic view from a 20-degree mesial or distal 
projection. In this respect, it becomes clear that extreme 
variations in root fusion are difficult to ascertain with 
radiographs. 
             Several studies have suggested methods to 
determine root canal curvature using periapical 
radiographs. Schneider proposed a method to determine 
curvature based on the angle that is obtained by two 
straight lines. The first is parallel to the long axis of the 
root canal, and the second passes through the apical 
foramen until intersecting with the first line at the point 
where the curvature starts. The formed angle (α) was 
named according to the degree of root canal curvature: 
straight: 5°, moderate, 10-20° and severe: 25-70°. 
             Determining the curvature of the root will permit 
the maintainance of the curves associated with 
continuously tapered shapes and prevents structural 
deformations of the endodontic instruments. In this way, 
disastrous consequences to root canal preparation can 
be avoided, such as loss of working length, apical 
transportation, creation of ledges, elbows, zips an 
perforations, and fracture of instruments[6]. 
                The ‘S’ shaped canal has two curves, with the 
apical curve being very difficult to negotiate. The 
chances of strip perforation are very high in these root 
canals. Depending on the degree of the apical curvature, 
in a few cases it is impossible to instrument this area. 
               Guttman [7] suggested preflaring the coronal 
one-third of the canal (at the expense of the tooth 
structure) to reduce the angle of curvature. Once this is 
done, it is easy to negotiate the remainder of the root 
canal.In this case, the buccal canal had a less severe 
curvature; hence this canal could be prepared in a 
crown-down technique using protaper rotary instrument. 
The palatal canal was doubly curved, thus a double flare 
technique was used to enlarge this canal.  
               The access cavity was flared in the coronal-
third, in order to reduce the angle of curvature; reducing 
the angle of curvature by flaring the access will make the 
approach to the second curve much easier [8]. Once this 
was done, the palatal canal was negotiable, up to the 
apex; Nickel-titanium k files, were used to prepare the 
apical portion of the root canal. Short amplitude filing 
was done to enlarge the apical portion and also to 
merge it with coronal-third of the root canal. Care was 
taken for over-enlargement as it can easily result in 
perforation. 
 
Conclusion 
 
With improvement in technology of file systems 
for example CONTROLLED MEMORY(CM) , challenges 
like bayonet canals can be dealt more effectively. 
Knowledge and recognization of canal configuration can 
facilitate more effective canal identification and 
unnecessary removal of healthy tooth structure. To 
address challenging mid root curvatures, understanding 
of  the complex root canal morphology and choosing a 
canal preparation technique, thorough irrigation, 
debridement and disinfection will ensure successful 
endodontic treatment in complex situations.  
 
References 
 
[1] Gupta S. Endodontic Miscellany: Conventional 
Endodontics for Complex root-canal morphology. 
Endodontology 2002; 14(1): 28-29  
[2] Ingle JI and Taintor JF. Endodontics. 3
rd
 ed. 
Philadelphia 1985; Lea & Febiger. 
[3]. Pucci FM and Reig R. Conductos radiculares. Buenos 
Aires 1944; Medico- Quirurgica. 
 [4]  Vertucci FJ. Root canal anatomy of the human 
permanent teeth. Oral Surg Oral Med Oral Pathol. 
1984 Nov;58(5):589-99. 
[5]  Cohen Missouri: Mosby – Year book Inc. 9th ed. 
2002. Pathways of the pulp; p. 152. 
[6] Estrela C, Bueno MR, Sousa-Neto MD, Pecora JD. 
Method for Determination of Root Curvature Radius 
Using Cone- Beam Computed 
[7]  Guttman JL. Problem solving in endodontics. 
Missouri: Mosby –Year book Inc; (3rd ed) 1997:116. 
[8]  Weine S. 6th ed. Endodontic therapy; p. 205 
 
9 


Managing the Risky Curve – A Case Report

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