endomontreal

Microendodontics case study number: 500446

A few days ago we were confronted to this three rooted mandibular first molar (Radix Molar or Radix Entomolaris), a rare anatomical variation of teeth, where a third supernumerary root is located distolingually in mandibular molars. Root canal system calcifications and a canal curvature with an "S" form made this endodontic procedure an extremely complex one.

In that specific case, endodontist  operative microscope was most helpful when striving to find the fourth canal entry in distal root, allowing for us not to omit the fourth deeply embedded root canal. This microendodontic case study enlightens how dental operative microscope may assist the practicing dentist into a more secure root canal procedure for his patient.

Clinical endodontic case study number: 505146 

A peculiar anatomical variation can be noticed on this mandibular first molar. What appeared to look like hypercementosis on apical aspect of distal root could in fact be a supernumerary root fused to the distal one (Radix Entomolaris). Careful removal of dentine with ultrasonic tips under high magnification of a dental operative microscope helped in locating this extra canal.  

Case report in microendodontics number 493847                                  Key words: Root canal anatomy, anatomical variation of teeth, radix entomolaris

The anatomy of the root canal system directly affects the success of the root canal treatment. This post presents a case report of a mandibular second molar with five canals and five different apical foramina. The intraoral clinical examination revealed a tooth affected with deciduous restoration, and a sinus tract. On radiographic examination, the distal root larger than average width did let us suspect the presence of four separate roots. Other radiographic findings: Alveolar bone with circumscribed radiolucent apical lesion. The diagnosis was a pulpal necrosis and a chronic suppurative periradicular periodontitis. Etiology: marginal leakage, caries. 

Endodontic procedure: 

First appointment: gaining coronal-radicular access to the 5 canals, locating entries, shaping and cleaning apical root canal branches inserting intracanal medication for 8 days. Third X ray image shows the fift short canal extending from pulp chamber to the interradicular space.

Second appointment: intracanal medication retrieval, copious CHX 2% irrigation, drying canals and permanent root canal obturation with Pulp Canal Sealer and gutta percha (lateral and vertical condensation).

In that specific case, the endodontist microscope insured a better prognosis for this patient because it has been most helpful  when striving to find the root canal split in distal root and because it prevented us from omitting the fifth root canal.

Even when complete root canal treatment has been carried out the patient still has to be periodically evaluated for prognosis.

Case number: 186336

A few days ago we were confronted to this three rooted mandibular first molar (Radix Molar or Radix Entomolaris), a very rare anatomic variation where a a third supernumerary root is located distolingually in mandibular molars. Tremendous amount of calcifications and a limited opening of the patients mouth made this endodontic procedure an extremely complex one. Dental Operative Microscope was most helpful in locating all canal entries.

To lurn more about Radix Entomolaris, please go to: R. Bansal & P. Ajwani: Prevalence and Morphological study Of Three Rooted Mandibular First Molar (Radix Molar) in Indian population. The Internet Journal of Human Anatomy. Volume 1 Number 1