Thai Endodontic Journal

Non-surgical Retreatment of a Taurodont Molar with Maxillary Sinusitis of Endodontic Origin: A Case Report

2026-03-24T10:58:23+07:00

Taurodontism is a dental anomaly characterized by an apically displaced pulpal floor and an elongated pulp chamber, which complicates root canal treatment due to its atypical root morphology. This case report presents the nonsurgical root canal retreatment of a taurodont maxillary first molar with an additional mesiobuccal canal associated with maxillary sinusitis of endodontic origin (MSEO). A 57-year-old male patient presented with dull pain at tooth 16, which had previously undergone root canal therapy. Clinical examination revealed dislodgement restoration with gutta-percha exposure, tenderness to percussion, and radiographic evaluation demonstrated underfilled root canals with periapical radiolucencies around the mesiobuccal and distobuccal roots. Cone-beam computed tomography (CBCT) confirmed the taurodont morphology, detected an additional canal, and revealed Periapical Osteoperiostitis (PAO). Under a dental operating microscope, all five canals (MB1, MB2, MB3, DB, and P) were negotiated, cleaned, and shaped using rotary instrumentation and supplemental irrigation. Calcium hydroxide was placed as an intracanal medicament, and obturation was performed using a hydraulic condensation technique with a bioceramic sealer. The patient remained asymptomatic after retreatment, and 2-year follow-up radiographs demonstrated complete periapical and sinus healing. This case highlights the importance of CBCT and magnification in identifying complex root canal morphology and achieving favorable outcomes in the retreatment of taurodont teeth with MSEO.

Non-surgical root canal retreatment: a case report of eleven silver cones removal in maxillary first premolar

2026-01-05T12:38:08+07:00

Modern endodontic therapy dismissed the use of silver cones as root canal filling due to their corrosion susceptibility, which ultimately leads to endodontic failure. When non-surgical retreatment is required, removal of silver cones can be challenging and potentially cause separation into fragments which may complicate retreatment procedures. This case report showcase a 68-year-old female patient, in which a sinus tract was found at the root apex of maxillary right first premolar tooth with local argyrosis in the corresponding region, which the patient was unaware of the condition. Radiographically, laterally condensed silver cones were suspected in the root canals, with radiolucency presented the apex. Eleven silver cones were successfully retrieved from both canals without any fragmentation or separation by engaging with Hedstrom files combined with braiding technique. Sinus tract was resolved following root canal disinfection procedures, and radiographic evidence indicated ongoing periapical healing after a one-year follow-up.

Minimal invasive endodontics: A comprehensive review on access preparation and mechanical instrumentation strategies - Part I: access cavity design

2026-06-20T21:17:05+07:00

Vertical root fracture (VRF) is a common contributing factor leading to extraction of endodontically treated teeth. Concerns regarding cracks and VRFs have therefore driven the development of minimally invasive endodontics (MIE), which initially focused on access cavity designs aimed at preserving coronal tooth structure and pericervical dentin (PCD) to enhance long term tooth survival.

Evidence from in vitro studies suggests that, from a mechanical perspective, MIE access cavities preserve more coronal tooth structure and upper PCD compared with traditional endodontic cavities (TEC), and are generally associated with lower cervical stress concentration. However, findings on fracture resistance and canal transportation are inconsistent, particularly in molars and structurally compromised teeth, where marginal ridge loss remains a dominant determinant of fracture risk regardless of access design.

From a biological perspective, evidence regarding cleaning efficiency remains inconclusive. Most studies report no significant differences between MIE and TEC in terms of remaining hard tissue debris or residual pulp tissue within the root canal system, whereas results concerning uninstrumented areas are conflicting. Importantly, increased access conservatism is associated with a higher risk of missed canals, especially in teeth with complex anatomy such as the second mesiobuccal (MB2) canal, likely due to reduced visibility. In addition, ultraconservative access designs are also consistently associated with greater root filling remnants in the pulp chamber, which may compromise coronal bonding and esthetics outcome.

Overall, while MIE access designs offer mechanical advantages through dentin preservation, their biological benefits and effects on fracture resistance remain uncertain. Access cavity design should therefore be case-dependent, considering residual tooth structure, anatomical complexity, operator experience, and the availability of adjunctive technologies. Further well-designed clinical studies are needed to clarify the long-term implications of MIE approaches.