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The success of nonsurgical endodontic management depends on the complete elimination of infection that compromises the tooth function. Thorough knowledge about the root canal anatomy is one of the principal factors in achieving a successful outcome. The morphology of root canals is not always typical. Maxillary molars, known for varied morphology, require advanced imaging modalities such as cone-beam computed tomography (CBCT). This case report describes a series of four maxillary molars with different forms, numbers, and configurations of root canals and with unusual morphology, including a case of a third mesiobuccal (MB3) canal, a case of a second mesiobuccal (MB2) canal with two palatal canals [mesiopalatal (MP) and distopalatal (DP)], a case of three mesiobuccal canals (MB1, MB2, MB3), three distobuccal (DB1, DB2, DB3) canals, and two palatal canals [mesiopalatal (MP) and distopalatal (DP)], and a case of taurodontism, where different access cavity modifications, diagnostic methods, and magnifications were considered.

Endodontic treatment of maxillary incisors may be considered straight forward. However, in some instances, they may exhibit aberrant morphology. One of these rare variations in tooth morphology is dens invaginatus. To improve the endodontic prognosis of such teeth, a detailed evaluation of the tooth under treatment is important, which requires comprehensive clinical and radiographic examinations, including periapical radiography and cone-beam computed tomography (CBCT), which is highly recommended whenever atypical root canal morphology is suspected on a periapical radiograph. The current case report discusses the diagnosis of type IV dens invaginatus in a maxillary lateral incisor using CBCT.

The aim of this study was to assess the efficacy of apical negative pressure (ANP), manual dynamic agitation (MDA), passive ultrasonic irrigation (PUI) and needle irrigation (NI) as final irrigation activation techniques for smear layer removal in curved root canals.Mesiobuccal root canals of 80 freshly extracted maxillary first molars with curvatures ranging between 25° and 35° were used. A glide path with #08-15 K files was established before cleaning and shaping with Mtwo rotary instruments (VDW, Munich, Germany) up to size 35/0.04 taper. During instrumentation, 1 ml of 2.5% NaOCl was used at each change of file. Samples were divided into 4 equal groups (n=20) according to the final irrigation activation technique: group 1, apical negative pressure (ANP) (EndoVac); group 2, manual dynamic agitation (MDA); group 3, passive ultrasonic irrigation (PUI); and group 4, needle irrigation (NI). Root canals were split longitudinally and subjected to scanning electron microscopy. The presence of smear layer at coronal, middle and apical levels was evaluated by superimposing 300-μm square grid over the obtained photomicrographs using a four-score scale with X1,000 magnification.Amongst all the groups tested, ANP showed the overall best smear layer removal efficacy (p < 0.05). Removal of smear layer was least effective with the NI technique.ANP (EndoVac system) can be used as the final irrigation activation technique for effective smear layer removal in curved root canals.