Diagnostic and Treatment Considerations

• Position in the arch: Mandibular second molar
• Tooth isolation: Simple pretreatment modification required for rubber dam isolation
• Canal and root morphology: Extreme curvature (> 30°) or S-shaped curve

Preoperative evaluation revealed extensive caries and a coronal fracture. Clinical testing supported a diagnosis of symptomatic irreversible pulpitis with symptomatic apical periodontitis.

While there were no patient conditions that exceeded a minimal level of difficulty, there were several diagnostic and treatment considerations that could potentially complicate and adversely affect the outcome of this case. The presence of caries and a fractured mesiolingual cusp made rubber dam isolation moderately difficult. In addition, being a second molar with an s-shaped mesial root created a very high level of treatment difficulty.