علی مرسلی - متخصص درمان ریشه

علی مرسلی - متخصص درمان ریشه دکتر علی مرسلی

جراح – دندانپزشک، متخصص درمان ریشه
بورد تخصصی اندودانتیکس

Root canal treatment of three mandibular molars with three different canal morphologies 🦷We often expect canal morpholog...
24/09/2026

Root canal treatment of three mandibular molars with three different canal morphologies 🦷

We often expect canal morphology to follow our mental assumptions and the textbook images we’ve seen throughout our training.
But in reality… it doesn’t always work that way.

Endodontics is full of surprises.

In the first case, you can see a highly unusual location of the canal or***ces.
In the second case, there is a second mesial canal.
The third case looks simple and rather conventional at first glance—but it isn’t quite that simple. Both the curvature and the thin roots make this case a real challenge.
But there is one bigger and more fundamental challenge that all three cases have in common:

Anesthesia!

If you’re a dentist who can perform painless root canal treatment on vital mandibular molars like these, you’re a good friend of mine!



درمان ریشه سه مولر پایین با سه مورفولوژی متفاوت

ما معمولاً انتظار داریم مورفولوژی کانال‌ها در درمان ریشه مطابق پیش‌فرض‌های ذهنی ما و تصاویری باشد که در کتاب‌های مرجع دیده‌ایم.
اما در واقعیت… همیشه این‌طور نیست.

اندو دنیای سورپرایزهاست!

در کیس اول، محل اوریفیس‌ها کاملاً غیرمعمول است.
در کیس دوم، یک کانال مزیال دوم وجود دارد.
کیس سوم در نگاه اول ساده و نرمال به نظر می‌رسد، اما آن‌قدرها هم ساده نیست. هم انحنا (Curve) و هم نازک بودن ریشه‌ها چالش‌های واقعی درمان هستند.
اما یک چالش بزرگ‌تر و اساسی‌تر در هر سه کیس مشترک است:

بی‌حسی!

اگر شما دندانپزشکی هستید که می‌توانید این مولرهای پایینِ وایتال را بدون درد برای بیمارتان درمان ریشه کنید، شما دوست خوب من هستید!

#اندودانتیکس #دکترمرسلی

3-Year Follow-up of Maxillary First Premolar Root Canal Treatment The patient’s chief complaint was a parulis (sinus tra...
23/09/2026

3-Year Follow-up of Maxillary First Premolar Root Canal Treatment

The patient’s chief complaint was a parulis (sinus tract) on the gingiva. Pulp vitality testing revealed no response from the maxillary first premolar, confirming pulpal necrosis.
Root canal treatment was completed in a single visit.
At the 3-year follow-up, the patient remained asymptomatic, with evident radiographic healing of the periapical lesion.

A good reminder that proper endodontic treatment and adequate follow-up are key to long-term healing.

Maxillary First Premolar Root Canal TreatmentVertucci Type VIIn my opinion, the most challenging aspect of this case was...
22/09/2026

Maxillary First Premolar Root Canal Treatment
Vertucci Type VI

In my opinion, the most challenging aspect of this case was not the relatively complex canal morphology, but rather isolation.
The palatal wall was severely compromised, making proper isolation dependent on the reconstruction of a sound wall capable of providing an adequate seal.
endodontics, achieving predictable isolation is not simply a technical detail—it is a fundamental part of creating the conditions for successful treatment.
#دکترمرسلی #اندودانتیکس #اندودنتیست

Mandibular Second Molar – Root Canal TreatmentOne of the most common patterns of caries affecting mandibular second mola...
21/09/2026

Mandibular Second Molar – Root Canal Treatment

One of the most common patterns of caries affecting mandibular second molars is distal caries associated with a mesioangularly impacted third molar. Delayed eruption or late removal of these third molars may lead to food impaction and, consequently, distal caries of the adjacent second molar.

If the caries extends apically beyond the level of the alveolar crest and surgical crown lengthening is not a predictable option, the standard treatment plan would naturally be extraction followed by implant replacement.

For the tooth shown in this case, extraction was also the initially recommended treatment option.

However, there is a special situation to consider:

If I can isolate the tooth, I may be able to save it.

In this case, following root canal treatment, the tooth can potentially be restored with a buildup by an experienced restorative colleague—and my colleague has accepted the responsibility for doing so. The patient also understands that, despite our efforts, the tooth may have a limited long-term prognosis.
But none of this means compromising on isolation.
The distal wall will be reconstructed with composite resin, allowing the root canal treatment to be performed under proper rubber dam isolation.
During the examination appointment, the patient asked me:

"Can you actually perform a proper, high-quality root canal treatment on this tooth?"

I told him that the root canal treatment I was about to perform would probably be much better than the RCT of the adjacent second molar.

Of course, good fortune favors preparation, focus, and experience.

And in this case, it turned out exactly that way.

Root Canal Treatment of a Maxillary Molar with a History of Previous Vital Pulp TherapyPerforming vital pulp therapy (VP...
21/09/2026

Root Canal Treatment of a Maxillary Molar with a History of Previous Vital Pulp Therapy

Performing vital pulp therapy (VPT) in mature permanent teeth has always been a challenging topic. Years ago, I was quite skeptical about this treatment approach. However, over time, my perspective on both VPT and its long-term outcomes has changed to some extent.
One of the reasons is that the commonly held belief that root canals inevitably become impossible to negotiate due to calcification following VPT—even when performed under magnification by a skilled clinician—does not seem to be strongly supported by clinical experience.
Most teeth that have undergone VPT remain amenable to root canal treatment if needed. Considering that the majority of VPT procedures are successful and do not eventually require RCT, the number of cases in which failure ultimately leads to tooth loss should theoretically remain relatively low.
This case involved a maxillary first molar with failed previous vital pulp therapy. Root canal treatment was successfully completed, including the negotiation of severely calcified canals.
A challenging case, but not necessarily an impossible one.

5-Year Follow-Up After Root Canal Treatment of a Maxillary Anterior Lateral IncisorThe maxillary lateral incisor was tre...
20/09/2026

5-Year Follow-Up After Root Canal Treatment of a Maxillary Anterior Lateral Incisor

The maxillary lateral incisor was treated endodontically 5 years ago following a diagnosis of pulp necrosis based on pulp vitality testing. At the time of treatment, the tooth was asymptomatic.
Following canal preparation and shaping, the canal was intermittently irrigated with 5% sodium hypochlorite and normal saline. Obturation was performed using the VWC technique with a bioceramic sealer (Sure Endo).
At the 5-year follow-up, the tooth remains functional and asymptomatic, with radiographic evidence of lesion healing.
-up

Orthograde Endodontic Retreatment of a Maxillary Premolar and MolarBoth teeth were successfully retreated in a single ap...
17/09/2026

Orthograde Endodontic Retreatment of a Maxillary Premolar and Molar

Both teeth were successfully retreated in a single appointment.
The main challenge was reaching the working length in the MB and DB canals.
The intermittent use of EDTA, saline irrigation, and sodium hypochlorite (NaOCl) was key to overcoming this challenge and achieving proper canal negotiation.

Root Canal Treatment of a Maxillary Anterior Lateral IncisorThis tooth had served as a crown abutment for many years. As...
16/09/2026

Root Canal Treatment of a Maxillary Anterior Lateral Incisor

This tooth had served as a crown abutment for many years. As part of the new treatment plan, the dentist preferred to restore the existing endodontically treated tooth with a new crown.
Pulp chamber calcification was evident on the preoperative radiograph. Only a few millimeters of dentin needed to be removed to locate the canal or***ce. However, those few millimeters had to be removed in the correct direction and at the correct location.
Magnification and appropriate cutting instruments are essential for performing a safe access preparation while preserving as much dentin as possible—especially in a tooth like this.
No additional intraoperative radiographs were required at any stage of the procedure.
#دکترمرسلی

When Orthograde Treatment Defies Expectations. A patient was referred with pain, swelling, and mobility of a mandibular ...
14/09/2026

When Orthograde Treatment Defies Expectations.

A patient was referred with pain, swelling, and mobility of a mandibular anterior tooth.
The extensive periapical lesion initially made me suspect that retrograde surgery might eventually be necessary.
However, vitality testing showed that the adjacent central and lateral incisors were vital and normal. The mandibular central incisor was the only tooth that tested negative, and its apical position corresponded precisely with the epicenter of the lesion.
So, only the affected central incisor was treated.
Root canal treatment was completed in a single visit, with obturation using a bioceramic sealer (Sure Endo, Korea).
Despite the extensive lesion and the potential need for surgery, I prefer not to rush into an apical surgical approach when the clinical situation allows. In the absence of persistent symptoms, I usually give the orthograde treatment 3–6 months or more before making a decision about surgery.
The patient returned for follow-up three years later.
The healing was remarkable.
Almost unbelievable.

And at 7 years, there was no radiographic evidence of the lesion.

No retrograde surgery.
No additional intervention.
Just orthograde treatment—and time.

With careful observation, the subtle outline of the previous lesion can still be appreciated on the final radiograph as an area of altered trabecular bone architecture.

I genuinely love endodontic microsurgery.

But this case is a beautiful reminder:

Even when surgery seems likely, sometimes the best thing we can do is give orthograde treatment a chance to heal.

Healing needs time. And sometimes, time does the magic.

Root canal treatment of a mandibular first molar.Initial radiographs are not expected to provide us with all the informa...
13/09/2026

Root canal treatment of a mandibular first molar.

Initial radiographs are not expected to provide us with all the information we need for root canal treatment. Whether it is a periapical radiograph or even a CBCT, imaging cannot reveal every detail.
For example, in this case, the severe canal curvatures in the apical third can only truly be appreciated once treatment is initiated.
Part of the diagnostic process in endodontics takes place at the very beginning of treatment. It is our knowledge and experience that prepare us to recognize and manage these anatomical challenges when we encounter them.

#اندو #اندودنتیست

Address

تهران جلال آل احمد، زیر پل گیشا (نصر)، پلاک ۷۱ طبقه چهارم مقابل ساختمان بانک کشاورزی/تلفن ۰۲۱۸۸۲۸۳۰۰۶ و ۰۲۱۸۸۲۸۳۰۰۷
Tehran

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