Navigating Complex Anatomy: A Systematic Approach to Bifurcated and Confluent Canals

Overview

In this live stream, we're revisiting a detailed session on managing complex root canal morphologies, specifically bifurcated and confluent (joining) canals. We focus on a challenging premolar case to demonstrate a systematic, crown-down approach for safely navigating and shaping these difficult anatomies from initial access through to final obturation.

Key Topics Covered

• Assessing complex anatomy like bifurcations, C-shapes, and confluent canals using radiographic evidence
• The critical importance of modifying the access cavity for straight-line entry, especially in teeth with crown-root angulation
• A step-by-step crown-down preparation technique: using an orifice opener first, followed by hand files, a rotary glide path file, and then shaping files
• Demonstration of the TruNatomy system, including the orifice opener, glider, and shaping files, in a clinical sequence
• Techniques for obturating canals that join, including downpacking one branch before placing the cone in the second to prevent blockage
• Tips for locating the second canal in bifurcated systems, such as using pre-curved hand files and removing coronal dentine shelves

Clinical Relevance

This video provides a highly practical and repeatable workflow for managing bifurcated and joining canals, which are common sources of procedural difficulty. The crown-down strategy we are shown significantly reduces the risk of ledging or blocking canals, making these challenging cases more predictable and less stressful to treat in day-to-day practice. 

Learning Outcomes

After watching this, we should be better able to:

• Apply a systematic crown-down approach to instrumenting complex canal systems
• Utilise pre-curved files and specific access modifications to locate and negotiate bifurcated canals
• Understand and implement obturation techniques suitable for confluent canal anatomy
• Feel more confident in managing the anatomical challenges presented by premolars and lower incisors