Five Challenges for an Endodontist
Five Challenges for an Endodontist
Course overview
The course is dedicated to 5 problems that endodontists frequently encounter:
Curved root canals (with double S-curve, with curvature greater than 90 degrees): location, mechanical and medicamentous treatment, obturation
Calcified root canals: CBCT, modified access, removal of denticles
Endodontic treatment of teeth under prosthetic crowns: decision-making strategy
Post structures in the root canal: step-by-step removal protocol depending on the type of post
Broken instruments: extraction or bypassing.
- Diagnose complex root canal anatomies, including severe curvatures and calcifications, using CBCT and clinical cues
- Plan access and mechanical strategies for negotiating and preparing calcified or severely curved canals safely
- Formulate decision pathways for managing teeth under prosthetic crowns and for post removal during retreatment
- Apply instrument‑separation management principles to decide between bypassing, retrieving, or leaving fractured fragments
What you will learn
Course lessons
Lesson 1. Treatment of curved canals
Mechanism of formation of a curved root
Diagnosis and identification of curved canals:
Radiographic diagnosis
CBCT.
Classification of curved canals
Protocol for working with curved canals:
Access cavity preparation
Localization of main orifices
Localization of accessory orifices
Preliminary canal enlargement
Final shaping of the root canal.
Philosophy of mechanical root canal preparation
Risks when working with curved canals:
Step formation
Blocking
Perforations
File separation: torsional and cyclic fatigue.
Principles of working with different types of curvature
Advantages of the Irriflex irrigation needle
Double S-curved canals: shaping protocol
Apical root canal curvature greater than 90 degrees: tactics.
Lesson 2. Treatment of calcified root canals
Calcification: definition and etiological factors
Diagnosis of calcified canals: clinical and adjunctive methods
Criteria for assessment and limits of radiographic imaging
CBCT in the management of teeth with obliterated canals
Multiple isolation: indications and advantages
Principles of access cavity preparation:
Traditional access
Modified access.
Protocol for negotiating the root canal
Treatment of an obliterated root canal: demonstration of technique
Complications when working with obliterated canals and their prevention: perforation
Clinical examples of perforation repair
Advantages of using the IrriFlex irrigation needle
True and false denticles: etiological factors
Indications for surgical treatment
Guided endodontic access: step-by-step protocol.
Lesson 3. Removal of indirect restorations (fixed prostheses) during endodontic treatment
Advantages of multiple isolation
Direct restorations of anterior teeth
Challenges in direct restoration of posterior teeth
Features of removing amalgam restorations
Principles of working with old composite fillings
Strategies for retreating teeth with indirect restorations:
Retreatment through the crown
Retreatment with complete crown removal
Retreatment with crown sectioning.
Instruments for removing crowns and bridge prostheses
Technique for crown removal using Metalift® and WAMkey® systems
Root canal obturation with the MAP One system.
Lesson 4. Removal of posts from root canals
Main objectives of retreatment and its differences from initial treatment
Indications for post removal
Types of posts and tactics for their removal:
Passive posts
Threaded posts
Cast post-and-core restorations
Fiber-glass posts.
Post removal with ultrasonic instruments
Technique for removing a fractured post
SybronEndo post removal system
Tips and recommendations for removing different types of posts.
Lesson 5. Removal or bypassing of fractured endodontic instruments
Primary treatment and retreatment: main objectives and differences
Causes of instrument separation in the canal:
Torsional stress
Cyclic fatigue
Canal geometry.
Instruments for removing fractured instruments
Remove the instrument or bypass it: criteria for choosing the treatment method
Protocol for bypassing an instrument:
Access preparation
Root canal preparation
Obturation.
Step-by-step protocol for removing a fractured instrument:
Using ultrasonics
Using an extractor.
Challenges in removing silver posts
Instrument removal systems:
Terauchi®
Endocowboy®.
