Sara Kim
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 ECENTLY, I have treated more and more patients with long roots. In general, it is known that African-Americans have long roots, and Asians have short roots, but I seem to be seeing many patients now with longer roots, regardless of ethnicity. For example, the average length of mandibular molars is 21 mm, but one patient who presented to me for root canal treatment had four canals with working lengths of 25.5–26.5 mm (Figures 1 and 2). Another patient had a working length of 34.0 mm (Figure 3 and 4), when the average length of a maxillary canine is 26.5 mm.
So, here are some tips about what to do when treating long roots. First of all, make sure that you have straight-line access. This can be achieved using a long-shank diamond bur and then using a surgical round bur to get rid of overhangs in the pulp chamber. Also make sure to open up the orifice so that there is no coronal binding. It is also important to get rid of the dentin shelf found between the mesial orifices in mandibular molars using an endo ultrasonic tip. It is easy to cause blockage in these long canals, so be sure to use copious irrigation and recapitulate frequently throughout instrumentation. Filling a long single canal like the canine I mentioned before is difficult because most gutta-percha points are not that long. For example, gutta-percha points from brands like Roydent are 31.0 mm, Dentsply Maillefer 30.5 mm, Henry Schein Maxima 28.5 mm, and Protaper 27.5 mm. Therefore, you can heat up two or three gutta-percha points and roll them into one thicker and longer piece using a spatula or two glass slabs. Solutions like chloroform can also be used to help soften the gutta-percha.
October - December 2010
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