Case Report of Missing Isthmus Endodontic Mishap

The primary objective of endodontic treatment is the comprehensive removal of diseased pulp tissue from the root canal system. This involves shaping and cleaning the canal, followed by filling it with inert material, effectively reducing or eliminating the risk of re-infection and thereby ensuring treatment success. Deviation from accepted clinical standards can result in treatment failure, particularly in cases of persistent apical periodontitis following conventional root end surgery.

The anatomical complexity within the root canal system includes a thin passage called an isthmus, housing pulp or tissue originating from the pulp. It is essential to recognize that the isthmus is not an independent entity but an integral component of the root canal system. The isthmus must be thoroughly cleaned, shaped, and filled. Endodontists need to be cognizant of the presence of isthmuses, especially in molars and premolars, located at the 3 millimeter level from the apex, occurring in approximately 80%-90% of instances requiring apical surgery.

The intricate nature of isthmus preparation contributes to a significantly lower success rate in teeth with isthmuses compared to those without. Teeth with existing isthmuses require greater weakening to create space for both canals, posing a challenge to the overall success of the endodontic procedure. Addressing this complexity is crucial for improving treatment outcomes and ensuring the long-term success of endodontic interventions

Author(s): Badria Al-Matrafi*, Reem Al-Idrisi, Hussein Mukhles, Hisham Zaidan, Abdulmajeed Al-Takhees, Al-Bishi Dalal, Saud Al-Saif, Amal alshehr, Norah Alotaibi and Mshael Almohaimel

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