endomontreal

Endodontist case study of root canal procedure number: 362515

Pecora al. in 1993 reported second maxillary premolars (among 435 studied) to have one root in 90,7%. The typical maxillary second premolar may be considered having only one root with a single canal among the Caucasians (Pitt Ford, 1997). According to Vertucci's study in 1984 on 200 maxillary second premolars, in 75% of the cases, a second maxillary premolar will present with only a single canal at the apex. The type V configuration occured only in 6% of the teeth examined by Vertucci and 9% of the teeth examined by Sert (2004) 

A Vertucci type V pulp space configuration can be described as follow: One canal leaves the pulp chamber and divides short of the apex into two separate distinct canals with two distinct foramina (1-2).

Preoperative radiological findings that might help us in suspecting such a pulp space configuration: root canal abruptly becomes invisible short of the apex. 

Only one file at a time could pass through the narrower root canal part in apical third, each root canal branch has been shaped cleaned and filled individually with lateral and vertical condensation. Root canal system is having canal curvature with an s form. 

Armamentarium: OPMI PROergo dental operative microscope from Carl Zeiss, Rubber dam and rubber dam clamp and frame, Stainless steel K endodontic files, gutta percha and Pulp Canal Sealer, finger plugger.

The name comes from the letter "C" shape appearance of a very large isthmus in the pulp chamber floor when viewed from above. This isthmus or groove is the result of the merging of some or all of the root canals at the cervical area near the pulp chamber floor. Incidence is 2,7% in Caucasian and up to 13% in asian population. Pre operative X Ray dental film shows a blurred image of the canal system, canals are not visible and pulp chamber is almost not visible. Looking at these features it may not be possible to diagnose a C shape canal but we must suspect either this canal configuration or severe fibrosis/calcification.

"C" shape canals are a real challenge to preparation and may cause technical complications such as transportation, steps, stripping with perforation in the thin wall area or blockage of the canal.

This procedure requires a full understanding of this anatomy to prepare an optimal access cavity to pulp chamber through a PFM abutment,  to know where to look for the root canal entries and to be cautious about the thin wall area. This endodontic procedure also requires much more operating chair time for debridment. No rapid techniques does exist to shape clean and fill those peculiar root canal shapes. This specific endodontic procedure also justifies the use of a dental operative microscope to better see what we are doing. 

Case number 319947

This 3D video of a "C" shaped second mandibular molar from the rootcanalanatomyprojectblogspot.com displays the complex anatomy of such a root canal system. In just a few second the video gives a better understanding on how difficult the cleaning and filling tasks of a "C" shape root canal may be.  

Last september, a new generation of endodontic file has been presented at the CAE meeting in Quebec city-Canada by Dr Zvi Metzger, Professor and Chair Department of Endodontology school of Dental Medicine at Tel Aviv University. Although at the moment, the Self Adjusting File System (SAF System) is not yet readily available everywhere in Canada, this innovative endodontic file adapts to root canal shape thus, may represent in a near future, a valuable approach to more efficient debridement in C shape canals and a safer way to address thin wall section that is always present in this anatomical variation. Here is a promotional video showing how it works. 

Conceived and maintained free of charge by a dentist in Montreal (Canada), for dentists, endodontists and patients alike,  endomontreal.com is dedicated to the exchange of substantive technical content, covering the full range of information requirements. Inviting members from the world wide web, speaking from a wide range of technical experiences, this forum addresses questions about the technical aspect of root canal procedure in dentistry today. Patients questions are also welcomed.

An important feature: A translating plugging powered by GOOGLE TRANSLATE located in the right column of this page may enable more dentists on the Web to "guess" in 48 languages what endodontics and more specifically what microscope in endodontics may bring to their patients.

endomontreal.com is weekly updated, stay tuned!

This week's new Dental Operative Microscope (D.O.M.) assisted root canal treatment displays an intricate root canal treatment procedure on a mandibular second molar presenting  a "C" shape root canal configuration.  This case report  in microendodontics number 319947 is highlighted with a 30 second video of a rotating 3 D image of a  "C" shaped second mandibular molar. These images and video may be obtained from "The root canal anatomy project" blog and where developed at the Laboratory of endodontics of Ribeiaro Preto dental school- University of Sau paulo by doctor Marco Aurelio Versiani and by doctor Jesus Djalma Pecora. The video displays the complex anatomy of such a root canal in red and gives us a better understanding on how difficult the cleaning and filling tasks of a "C" shape root canal may be.  

Root canal procedure case study number: 49821617

Note on the post operative Xray dental film, the dilacerated apical curves in both vestibular roots on second maxillary molar and disto vestibular root of first maxillary molar. The values of those root canal curvature radius based on three mathematical points are all below 4 mm, these are very small radius. Thus, those cuvatures can be defined as severe. For the endodontist, choosing the right endodontic file is of the utmost importance in order to avoid damaging consequences such as: apical transportations, loss of working length, zip and perforations and fracture of instruments.

An interesting point has been raised by Drs Pruett, Clement and Carnes affiliated with the Department of Endodontics/Dental School of University of Texas Health Science Center at San Antonio:" These results indicate that, for nickel-titanium, engine-driven rotary instruments, the radius of curvature, angle of curvature, and instrument size are more important than operating speed for predicting separation".  

Much more can be learned on small curvature radius by reading the following article:  Method for determination of root curvature radius using cone beam computed tomography images                  Carlos Estrela, Mike Reis Bueno, Manoel Damiao Sousa Neto, Jesus Djalma Pécora Braz Dent J (2008) 19(2): 114-118 ISSN 0103-6440

A new Dental Operative Microscope (D.O.M.) assisted root canal treatment in a maxillary second molar presenting  a partial mineralization of it's root canal system.  This case report  in microendodontics number 49821617 displays an intricate procedure on a mineralised root canal systems with a very small radius curvature. Choosing the right instrument is of the utmost importance  in order to avoid damaging consequences such as: apical transportations, loss of working length, zip and perforations and fracture of instruments.

Conceived and maintained free of charge by a dentist in Montreal (Canada), for dentists and endodontists,  endomontreal.com is dedicated to the exchange of substantive technical content, covering the full range of information requirements. Inviting members from all over the world, speaking from a wide range of technical experiences, this forum addresses questions about root canal procedure aspect of dentistry today. 

Pierre Pizem

A new Dental Operative Microscope (D.O.M.) assisted root canal treatment in a maxillary second molar presenting  a partial mineralization of it's root canal system.  This case report  in microendodontics number 449927 displays an intricate procedure on a mineralised very long root canal system with a curvature with an"S" form. This procedure displays as well a second mesiovestibular root canal entry location with the help of a microscope. 

Conceived and maintained free of charge by a dentist in Montreal (Canada), for dentists and endodontists,  endomontreal.com is dedicated to the exchange of substantive technical content, covering the full range of information requirements. Inviting members from all over the world, speaking from a wide range of technical experiences, this forum addresses questions about root canal procedure aspect of dentistry today. 

Pierre Pizem

Endodontic procedure case study number: 449927

To treat such a tooth in endodontics we needed to deal with:

• Difficult access
• Long tooth (24 mm)
• Calcified canals (root canal system with dystrophic calcifications) to locate, shape clean and fill 
• Second mesiovestibular (Mb2) to strive for with the help of a dental operative microscope
• Canal curvature with an "S" form (Bayonet shaped root canal) 

Armamentarium:

PRO Taper endodontic files from Dentsply, OPMI PROergo dental operative microscope from Carl Zeiss, Gutta Percha from META, Pulp Canal Sealer from KERR 

Case report in microendodontics number: 500047

Canal curvatures are a challenge to preparation and can be the origin of many technical complications leading to failure of treatment. Canals that curve in the mesio-distal direction are usually readily detected in radiographic dental films. However, as it is the case here, many canals curve also in the bucco lingual direction.  The bucco lingual aspect of this sharp curvature has been displayed using a mesio distal angulation of our X ray cone beam.

An endodontist Dental Operative Microscope (D.O.M.) assisted root canal treatment in a mandibular second molar presenting  a partial mineralization of it's root canal system.  This case report  in microendodontics number 500047 implies an intricate procedure on both a mineralized and a severely curved root canals system.