This case report aims to describe the endodontic treatment of a tooth with severe root dilaceration, using manually operated instruments made of heat-treated NiTi. A 14-year-old male patient, with a surgically treated cleft palate, was referred for endodontic treatment of the upper left lateral incisor (#22) for prosthetic reasons. Clinical examination revealed a crown formation defect in the affected tooth. Initial radiographic examination showed severe root dilaceration in an “S” shape. Under local anesthesia and rubber dam isolation, the coronal access was performed and initial canal exploration was done with a C-Pilot #10 instrument, followed by a pre-curved Flexofile #15, until the real tooth length (RTL) was reached.
Due to the curvatures, manual instruments from the ProDesign M system were used, with the preparation completed using instrument #35/.05. Because of specific challenges related to absolute isolation, 2.0% chlorhexidine digluconate combined with 0.9% saline solution was chosen, with the RTL as the working length. After overcoming the difficulties of preparation, obturation was performed 1.0 mm short of the RTL, using the single-cone technique combined with AH Plus sealer. Finally, the coronal access was sealed with glass ionomer cement. The final radiograph revealed preservation of the original anatomy. Based on the above, it can be concluded that the ProDesign M system was effective in shaping the curved canal, respecting its original anatomy even in the presence of severe curvatures, justifying its use.
