Discussion
A dilacerated tooth has been described as one tooth in which the root is
curved 90° or more to the long axis of the tooth, or one tooth in which
the apical portion of the root is more than 20° from the axis (8, 9). A
study of 3150 teeth from 800 patients in Iran found a 1.65% prevalence
of tooth dilacerations: 7.5% in males and 5% in females. Mandibular
third molars exhibited the highest occurrence of dilacerations at 14%.
(2). A dilaceration in root canal significantly increases the risk of
procedural accidents, including loss of apical patency, canal
transportation, perforation, ledge formation, and instrument fracture,
which could compromise infection control and the treatment outcome (10).
To enhance the effectiveness of root canal treatments and minimize
complications, a comprehensive understanding of the complex anatomy of
tooth canals is essential (11). Detailed information on root canal
curvature and complexity of dilacerated tooth aids in the proper
planning of treatment, and selection of appropriate materials and
techniques (12, 13). Studies have stated the importance of 3D imaging
modalities such as CBCT for the proper visualization of canal
morphology, which is of paramount importance to avoid mishaps like
perforation or transportation during instrumentation (13). The
implication of this thorough understanding is not only in the
enhancement of procedural efficiency but also in guaranteeing the
long-term success of endodontic treatments (13). Also, modern NiTi
rotary instruments and dynamic irrigation improve speed, safety, and
outcomes in complex root cases (6, 7). The single-cone, warm vertical
compaction, and lateral condensation techniques are common methods for
obturation in curved canals, each varying in effectiveness (8). A strong
seal using appropriate filling materials is key to preventing infections
and enhancing longevity post-procedure (9, 10, 11).
In dilacerated teeth, prior to starting root canal treatment, the
radiograph should be used to determine the degree of canal curvature.
The junction of a straight line from the orifice through the coronal
portion of the root and another straight line from the apex through the
apical portion of the canal forms the interior angle (12, 13). The
Schneider approach categorizes the canals into three groups: I) straight
(0–5°), II) moderate (5–20°), and III) severe (>20°); thus,
moderate and severe were classified as curved canals (14, 15). But, in
measuring double-curved root curvature, the method of Southard et al. is
more effective as it utilizes three lines in differentiating curve
angles compared to Schneider’s method, which was concerned with only a
single curvature angle by measuring the deviation between the coronal
and apical path of the canal (16, 17). This technique quantifies
curvatures by calculating two angles: the first is between the long axis
of the file’s coronal shaft and a ”best fit” line representing the
canal’s initial curvature, while the second is between this line and the
apical segment (16).