Objectives

This case aims to discuss the importance of glide path preparation in endodontics. It should help the reader to better understand why and when glide path preparation is indicated and how to achieve glide path during the endodontic procedure.

Introduction

A 21‐year‐old female patient presented with intermittent pain and biting sensitivity from the upper right first molar (UR6). During the endodontic consultation, the patient mentioned that she had not received any previous dental intervention on this tooth. However, she described previous infectious episodes treated by antibiotics.

Chief Complaint

Several previous infectious episodes requiring antibiotics.

Medical History

Unremarkable.

Dental History

The discomfort started five months ago with slight biting sensitivity related to the right maxillary first molar that increased over time. The relevant history included two consecutive infectious episodes with maxillary sinus involvement. The patient was prescribed antibiotics. After visiting a general practitioner, she was referred to the endodontic department.

Clinical Examination

Extraoral examination was unremarkable. Intraoral examination revealed satisfactory oral health with acceptable oral hygiene and the periodontal probing depths were all less than 2 mm. Tooth UR6 showed an occlusal carious lesion and was tender to percussion. The adjacent teeth were intact with no evidence of caries or restorations present and responded normally to pulp sensitivity tests, while tooth UR6 did not respond. No abnormal mobility was noticed. A pre‐operative periapical radiograph was taken (Figure 4.2.1).

The periapical radiograph revealed:

• Good bone level.
• Deep occlusal carious lesion.
• Large periapical radiolucency around the palatal and disto‐buccal (DB) root.
• Initial coronal curvature and apical curvature of the mesio‐buccal (MB) canal(s).

Taking into consideration the dental history, the anticipated anatomy of the mesio‐buccal root, the extent of the radiolucency and the suspected maxillary sinus involvement, pre‐operative cone beam computed tomography (CBCT) was taken.

The pre‐operative CBCT revealed (Figure 4.2.2):

• The extent of the carious lesion (blue arrow).
• The root canal curvatures. An abrupt apical curvature was seen in the apical third of the DB root.
• The presence of an MB2 canal only detectable in the coronal third (white arrow).
• A wide accessory canal in a buccal direction located at the junction between the middle and apical third of the palatal root (green arrows).
• A wide radiolucency surrounding the three roots indicating extensive osseous destruction (red arrows).
• The persistence of a thin bone layer between the periapical radiolucency and the maxillary sinus.
• Localised thickening of the sinus membrane (pink arrows).

Diagnosis and Treatment Planning

The diagnosis of the UR6 was pulpal necrosis with symptomatic apical periodontitis.

Treatment

The root canal treatment required two visits.