علی مرسلی - متخصص درمان ریشه

Photo 1

Root canal treatment of two abutment teeth supporting a bridge — completed in a single visit.
Performing complex endodontic treatments in one appointment requires much more than clinical skills and advanced equipment. It demands coordination, preparation, and most importantly, a dedicated and well-trained team. Their support allows me to focus on the treatment while ensuring that every logistical and clinical detail runs smoothly, ultimately improving productivity and patient care.
Behind every successful root canal treatment lies not only technology and expertise, but also the commitment of the people working behind the scenes. The clinic team plays a crucial role in shaping each patient's experience through their professionalism, dedication, and compassion.

I am deeply grateful to my colleagues, who contribute at every step of the process—from procurement and sterilization to patient communication, chairside assistance during treatment, and countless other tasks that often go unnoticed.

Photo 2: Aida, Hengameh, Maryam

Photo 3 – Aida
Friendly, positive, thoughtful, technically skilled, and the creative mind of our clinic.

Photo 4 – Maryam
Serious, tireless, committed, intelligent, and kind-hearted and honest.

Photo 5 – Hengameh
The youngest member of our team; dedicated, hardworking, energetic, reliable, and wise beyond her years.

Photo 6 – Parisa
The longest-serving member of our clinic; kind, empathetic, organized, and an exceptional manager who genuinely cares about our patients.

P.S.
Bita, another valued member of our team and one of our finest assistants, is unfortunately not present in these photos.

rootcanalspecialist iranianendodontist endo

Root Canal Treatment of a Maxillary Second Molar with Severe Curvatures and a Bayonet-Shaped Distobuccal Canal

Many of you who follow this page may look at a case like this and consider it beautiful. Some may even hope that every challenging case they treat ends up looking like this so it can be shared and showcased. But the truth is that the beauty of this case lies primarily in the tooth itself and its natural anatomy—albeit an uncommon one.
As clinicians, we are not painters or artists. Our craft is not creating beautiful radiographs; it is relieving pain, eliminating disease, preserving teeth, and restoring function. A pleasing radiographic outcome can certainly be a byproduct of good endodontic treatment, but endodontics is not about radiographs, nor is it about aesthetics.
Treating a maxillary second molar without proper isolation, without a rubber dam, without locating the MB2 canal, without achieving profound anesthesia, and without ensuring that the patient leaves the clinic comfortable, satisfied, and free of unpleasant memories—even if the final radiograph looks perfect—cannot be considered beautiful, nor can it be considered a true success.

We do not treat radiographs, and we do not create works of art. We treat patients. The real impact of our work is measured in the oral health, comfort, and quality of life of those who trust us with their care.

Mandibular molars may occasionally present with an additional root known as Radix Entomolaris (RE). Recognizing this anatomical variation is essential for accurate diagnosis, proper access design, and successful root canal treatment. Careful radiographic evaluation and even simple periapical imaging can help identify these challenging cases and improve treatment outcomes.

Assessing success or failure in endodontics is not always straightforward. Treatment outcomes are multifactorial and rarely follow a simple linear path.
This retreatment of a maxillary first molar was performed seven years ago. Today, the tooth remains asymptomatic and fully functional.

During retreatment, the second mesiobuccal canal (MB2), which had been missed during the initial treatment, was identified. However, during canal preparation, a rotary instrument separated within the canal.
No attempt was made to remove or bypass the separated instrument, and treatment was completed with the fragment left in place.
Seven years later, despite this procedural complication, the tooth remains functional and symptom-free. It may continue to remain asymptomatic and functional for an unpredictable period of time.
This case serves as a reminder that endodontic outcomes cannot always be judged by a single factor or procedural event. Long-term success depends on the complex interaction of multiple biological and technical variables.
#اندونتیست

Slide 1

Nonsurgical Retreatment of a Mandibular Second Molar

In this case, inadequate canal preparation, failure to reach the full working length, and lack of apical patency were likely the main reasons for the failure of the initial root canal treatment.
An important point regarding the mesial root is its Vertucci Type II canal configuration. In such cases, the two canals merge only a few millimeters short of the apex. Failure to recognize this anatomy may compromise cleaning, shaping, and obturation of the apical portion of the root canal system.

Slide 2

Root Canal Treatment of a Maxillary First Premolar

This case demonstrates another anatomical challenge. Two narrow, parallel canals converge very close to the apex, effectively functioning as two separate canals throughout most of their course.
Interpreting the preoperative radiograph—and even the postoperative radiograph—as showing a single canal is not unusual and can easily occur. Careful assessment and attention to anatomical variations are essential for successful treatment outcomes.

rootcanalspecialist iranianendodontist endo

This maxillary lateral incisor had undergone root canal treatment by an endodontic colleague several months earlier. Prior to treatment, the tooth presented with an acute abscess, and all acute symptoms resolved completely following the procedure.
However, approximately five months later, the patient still reported tenderness upon palpation of the buccal aspect of the root in the gingival area.
My recommendation was continued follow-up and observation, as healing might still have been ongoing. Nevertheless, the patient preferred active intervention due to the persistent discomfort in the area.
To address the patient's chief complaint while preserving the tooth, the only feasible treatment option was endodontic microsurgery. Root-end resection (apicoectomy) was performed, followed by placement of a retrograde filling material.

Clinical and radiographic images of the procedure are shown below.

One-year follow-up of two challenging cases: a mandibular second premolar and a mandibular first
molar.

Case 1 – Mandibular Second Premolar
The tooth presented with pulpal necrosis, a periapical lesion, and Grade II mobility at the initial examination. Generalized periodontal bone loss was also evident.
At the one-year follow-up, radiographic healing of the periapical lesion is highly satisfactory. The tooth remains functional, and mobility has returned to within normal limits. An interesting finding is that almost all of the bioceramic sealer extruded beyond the apex into the periapical tissues has been resorbed and is no longer radiographically visible.

Case 2 – Mandibular First Molar Retreatment
This case was retreated after two consultation visits. My recommendation was extraction and implant replacement, but the patient strongly preferred to retain the natural tooth.
From an endodontic perspective, the retreatment outcome has been excellent, with favorable healing and retention of the tooth. However, the one-year follow-up revealed a significant prosthodontic issue. Clinical and radiographic examination demonstrated incomplete seating and marginal discrepancy of the crown.
The patient was informed that long-term preservation of this tooth will depend not only on successful endodontic treatment but also on correction and reassessment of the prosthetic restoration. Endodontic success alone cannot compensate for a compromised coronal seal.

The Story of a Sweet Failure

More than ten years ago, this mandibular first molar was referred to me for root canal retreatment after an unsuccessful attempt by a colleague.

The distal canal had been ledged, the mesial canals had not been fully negotiated to working length, and the tooth was referred in the middle of treatment under less-than-ideal circumstances.

Given the complexity and unpredictable prognosis, extraction was my first recommendation.
However, the patient was determined to keep the tooth and wanted every possible option for preservation to be explored.
Retreatment was performed, but as expected, the distal ledge could not be bypassed. I then proceeded with apical surgery. During the surgery, because of the lesion associated with the mesial root, I decided to surgically manage that root as well.
To be fair, that part of the procedure was not ideal. The resected apical fragment could not be completely retrieved and was slightly displaced into the periapical area.
Still, the tooth was restored with a post and crown and went on to function comfortably and symptom-free for more than a decade.
A few days ago, the patient returned with a parulis adjacent to the bifurcation area. Clinical and radiographic findings confirmed a vertical root fracture, and extraction became the definitive treatment plan.
Every tooth has its own story.
This story ended with extraction, but not because the retreatment or surgery failed in the way we usually define failure.
For more than ten years, this tooth remained functional, asymptomatic, and valuable to the patient.
And in both the patient’s view and mine, that journey was still a meaningful and worthwhile success.

rootcanalspecialist iranianendodontist endo

A patient presented with a buccal abscess associated with the apical region of the maxillary lateral incisor, along with this initial radiographic appearance.
Despite the apparently acceptable radiographic quality of the previous root canal treatment, the presence of an extensive lesion and a foreign body located in an unusual position ruled out orthograde retreatment in my treatment plan.
Some fellow endodontists may disagree with surgical intervention as the sole treatment approach, or may prefer to attempt orthograde retreatment first. In healthcare systems supported by private or public insurance, or in situations where patients can be convinced to undergo an initial treatment phase with a questionable prognosis, such an approach may be reasonable. However, based on this patient’s specific condition and my clinical judgment, orthograde retreatment was not considered a predictable option for this case.
The apical surgery was completed in a sequential and focused manner, including removal of the foreign body, root-end resection, retrograde placement of a calcium silicate material, putting bone substitutematerial, membrane placement, and suturing.
As you can see, the foreign body was an extruded fragment of gutta-percha beyond the apex.
The overall prognosis of the treatment is considered favorable.

To me, the gold standard of competency in endodontics is the treatment of maxillary second molars.
The ability to manage these cases is often what separates a general dentist from someone truly proficient in endodontics.
One of the biggest challenges in treating upper second molars is locating the MB2 canal.
This post is not about the prevalence of MB2s or their direct role in treatment success or failure.
The point is that the very ability to locate an MB2 canal is itself a marker of clinical skill. A clinician who can consistently find the MB2 in a maxillary second molar is usually capable of handling many of the other critical factors that contribute to successful endodontic treatment.
But finding the MB2 canal in second molars without magnification is genuinely difficult. A dental operating microscope is, in my opinion, an essential tool for locating the second mesiobuccal canal.
The first two slides show two consecutive maxillary second molars treated during today’s shift — and both had MB2 canals.

The Eighteeth microscope was a tremendous help in both cases. Its flexible and excellent focal range, high-quality optics, and ergonomic design make complex endodontic treatments significantly more predictable and enjoyable.