When a Premolar Plays Tricks: Managing a Rotated Root

Tooth 13 presented with symptomatic irreversible pulpitis but no periapical involvement. Despite appearing normal after a well-executed bridge restoration, CBCT revealed the premolar was significantly rotated, with roots canted in opposite directions — hidden anatomy that made access and canal location especially challenging. See how careful planning, unconventional rubber dam isolation, and CBCT guidance managed the rotated roots, with strategies for maintaining access accuracy, recognizing file fatigue, and achieving predictable shaping and obturation in complex anatomy.