UR6 Endo and Direct Composite

Minimally Invasive Endodontic Management and Conservative Restoration of a Maxillary First Molar with Complex Root Curvatures

Overview:

In this video, Jon discusses the endodontic and restorative management of a maxillary first molar with significant root anatomy. He focuses on the importance of structural preservation and the use of flexible instrumentation to navigate severe curvatures while avoiding the need for full-coverage restorations.

The Case & History:

A 21-year-old patient presented with symptoms of irreversible pulpitis in the upper right first molar, characterised by lingering pain following thermal stimuli. Clinical examination revealed recurrent caries beneath an existing occlusal composite resin restoration. Radiographic analysis showed complex root anatomy, including a severe curvature in the mesio-buccal root and a long, subtle curvature in the disto-buccal root. Given the patient’s age and the remaining tooth structure, every effort was made to preserve the tooth through conservative measures.

The Clinical Problem:

The clinician faced the dual challenge of navigating highly curved canals and determining the most appropriate long-term restorative plan. Jon emphasises a minimally invasive access cavity to preserve the marginal ridges and enamel struts, which maintains the tooth's structural integrity. He explains the use of reciprocating, martensitic instruments to manage the root curvatures safely and stresses the importance of a pristine pulp floor—free from sealer and gutta-percha remnants—to ensure an optimal coronal seal. By preserving the key mechanical features of the tooth, the need for a crown or onlay was successfully avoided.