ENDODONTICS Case Spotlight: Unlocking a Complex Central Incisor with 3D Imaging and Nerve Mapping Technology

This video showcases Dr. Maya Prabhu, from Mid Jersey Endodontic Group in New Jersey, and how she planned her access for a difficult case using the Carestream 3D Imaging software and then executed her plan perfectly.

In the video, Dr. Maya used advice from my previous video showcasing: How to Minimize Your Access for Root Canals via Carestream 3D Imaging Software.

In this clinical case, Dr. Maya shares the journey of treating a complex root canal on a 15-year-old patient’s tooth #8—a case that highlights the value of CBCT imaging, nerve canal mapping, and real-time digital planning.

The Patient and the Challenge

The patient, a 15-year-old male, presented with symptoms on tooth #8 following a history of early trauma. According to his mother, he had multiple facial falls in infancy—compounded by an undetected peripheral vision defect—which led to a primary incisor being extrusively luxated and later pushed into the alveolus. As a result, his permanent incisors erupted as malformed “fists,” requiring bonding and orthodontic treatment.

Years later, one of those teeth (tooth #8) became symptomatic, leading to a referral for endodontic therapy.

Initial Findings

At first glance, the tooth appeared normal thanks to excellent composite bonding. However, a CBCT scan revealed a different story. Axial, coronal, and sagittal slices showed an unusually complex canal system in tooth #8—likely a C-shaped system with multiple canals. What appeared to be three canals soon proved to be more.

Dr. Maya, unsure of the optimal access point, considered removing the composite and locating the canals traditionally. But after receiving a video demonstrating a nerve/canal mapping tool built into her 3D imaging software, she decided to try a digital planning approach instead.

The Power of Nerve Canal Mapping

Using the CS 3D imaging software’s canal mapping feature, Maya mapped the canal trajectory, adjusted the canal diameter settings, and visualized the exit points. This proved crucial in planning a conservative and strategic access—beginning with the largest palatal canal and using it as a reference to locate the remaining canals.

Intraoperative Discoveries

Intraorally, the case became even more complex. The palatal canal bifurcated deeper in the root, creating a fourth canal—an anatomy not visible on the initial scans. Dr. Maya had to adapt mid-procedure, placing gutta-percha points into multiple canals and reorienting her access to find the elusive facially-positioned canal.

Practical Clinical Tips

To mirror the scan image accurately in her mirror during the procedure, Dr. Maya flipped screenshots of the 3D scan to eliminate confusion from lateral inversion. She also placed the rubber dam to maintain a clear view of the cervical margins, ensuring spatial orientation throughout the access.

Outcome

After locating and treating all four canals, including a discolored one that required internal bleaching, the case was completed successfully. A follow-up visit showed positive response to the bleaching and a happy, symptom-free teenage patient.

Takeaway

This case reinforces the power of 3D imaging combined with advanced canal mapping tools in endodontics—especially in complex anterior cases. By leveraging the digital tools available within her CBCT platform, Dr. Maya transformed what would have been a highly uncertain case into a predictable, minimally invasive, and patient-centered success.

Final Thoughts

As Dr. Maya noted:

“The software was true in this case. I didn’t fully trust it at first, but it led me right to the canal.”

With tools like 3D canal mapping becoming more accessible in CBCT platforms, clinicians now have a powerful ally in tackling endodontic anomalies and improving treatment outcomes.

📌 This case was shared as part of a video series on using advanced endodontic imaging tools. For more clinical walkthroughs, digital dentistry tips, and software tutorials, stay tuned or contact us for product training.