Management of a Very Long-Rooted Mandibular Second Molar in Close Approximation to the Inferior Alveolar Nerve

This case involved a mandibular second molar with unusually long roots and close approximation to the inferior alveolar nerve (IAN), presenting multiple challenges both inside and outside the canal system. The patient’s condition was complicated by the presence of a separated file, difficulty in negotiating a severely curved distal canal, and the necessity of mechanical preparation and obturation without overfilling or extrusion due to the proximity of the IAN. Management began with separated file retrieval. A conservative approach was prioritized, with bypass chosen as the initial option to preserve dentin integrity. Under magnification, careful scouting and negotiation were performed until the file could be bypassed successfully. Bypass is the first option to be more conservative The distal canal presented the…