endomontreal

Case study number 125546. An intricate root canal procedure on a mandibular first molar distal root canal. 

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 distinct foramina (1-2). According to Vertucci’s study in 1984 on a 100 mandibular molars sample, the type V configuration in distal root, occured only in 8% of the teeth examined. In the apical third of distal root, each part of the split  has been individually filled with Pulp Canal Sealer and gutta percha. (Lateral and vertical condensation). In order to do so, some gutta percha had to be removed in coronal, middle and apical third of distal root canal once lingual branch of the split has been filled. This was necessary to regain complete access to the vestibular branch apex.

An intricate root canal procedure, case study number: 49736

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 distinct foramina (1-2). According to Vertucci’s study in 1984 on a 100 mandibular molars sample, the type V configuration in distal root, occured only in 8% of the teeth examined. In the apical third of distal root, each part of the split as been individually cleaned, shaped and filled with gutta Percha and Pulp Canal Sealer. 

Please note the bayonet shaped root canal in distal root. 

An intricate root canal procedure. Case study number 119711

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 distinct foramina (1-2). According to Vertucci’s study in 1984 on a 100 mandibular molars sample, the type V configuration in distal root, occured only in 8% of the teeth examined. 

X ray with ISO files number 08 and 06 in distal single canal of lower left first molar shows an apical split in its last apical third. This is another Vertucci’s class V canal configuration. Each part of the split in distal root has been individually cleaned and shaped. NiTi files allowed us to follow both right-angle curves. Root canals have been obturated with Pulp Canal Sealer and gutta percha. (Lateral and vertical condensation). Last (Angulated) X ray to the right shows the obturated split as well as an anastomosis mesio vestibular and mesio lingual canals. ( a Vertucci’sType II canal configuration)

A type V canal configuration in palatal canal

Endodontic retreatment on lower right first premolar (Vertucci's Type V canal configuration) Pre operative X ray film shows: 1- First separated instrument in lingual canal 2-Second separated instrument in vestibular canal Second X ray film (post operative from first session) shows the other fragment yet to be removed with the help of a surgical operative microscope. Provisional material obturation left in canal is called Clip from Voco. Not very radio opaque but still is an excellent provisional material easy to insert and remove. Second appointment post operative showing second fragment removal and Ca (OH)2 with barium sulfate dressing in canals. Acrylic crown with radicular retention has been cemented with Temp Bond. Fourth X ray shows final root canal filling with casted post for try in at third appointment. Last X Ray shows a 7 years post operative outcome. Sealer extrusion into the periapex vanished, tooth is asymptomatic and has been a partial denture keytooth since then.

Extreme endodontic procedure. Case number: 334

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 distinct foramina (1-2). According to Vertucci’s study in 1984 on a 100 mandibular molars sample, the type V configuration in distal root, occured only in 8% of the teeth examined. In the apical third of distal root, each part of the split as been individually cleaned, shaped and filled with gutta Percha and Pulp Canal Sealer. 

This is a type V Vertucci's root canal configuration on a SECOND maxillary molar palatal root canal. An extremely complexe root canal configuration to clean shape and fill. The root canal is already very difficult to perform due to tooth position in the arch. Patient was having an A.A.A. at this time, making this experience a challenging one for both of us… Treatment took a total of three appointments because of the apical delta and because of calcified second mesiovestibular canal to treat.

Esta es una configuracion de canal radicular tipo V Vertucci's;de un conducto radicular palatino en un segundo molar maxilar(superior). Una configuracion radicular extremadamente compleja para limpiarla y llenarla. El tratamiento radicular(endodoncia) es  muy dificil llevar a cabo debido a la posicion del diente en el arco. El paciente estaba teniendo un A.A.A. al mismo tiempo, haciendo de esta experiencia un reto para ambos… El tratamiento tomo un total de tres citas por el delta apical encontrado en el canal palatino y por la calcificacion del segundo canal mesiovestibular tratado.

An intricate root canal procedure. Case study number 405

A Vertucci type V pulp space configuration (also called apical delta) can be described as follow: One canal leaves the pulp chamber and divides short of the apex into two separate distinct canals with distinct foramina (1-2). According to Vertucci’s study in 1984 on a 100 mandibular molars sample, the type V configuration in distal root, occured only in 8% of the teeth examined. In the apical third of distal root, each part of the split as been individually cleaned, shaped and filled with gutta Percha and Pulp Canal Sealer. An unusual palatal root anatomy makes this apical delta canal configuration difficult to clean shape and obturate.

Sharp curve in disto-vestibular root canal requires extra labor work.

Intricate endodontic procedure, case study number: 417

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 distinct foramina (1-2). According to Vertucci’s study in 1984 on a 100 mandibular molars sample, the type V configuration in distal root, occured only in 8% of the teeth examined. In the apical third of distal root, each part of the split as been individually cleaned, shaped and filled with Gutta Percha and Pulp Canal Sealer. 

This is a very long tooth, it's position in the arch (second molar), it's sharp curve and it's apical third split in distal root canal, are all factors wich are listed in the high difficulty category of the American Association of Endodontists (A.A.E.) Endodontic Case assessment Form. Thus, this specific case, according to the American Association of Endodontists, present exceptionally complicated preoperative condition, exhibiting several factors listed in the HIGH DIFFICULTY category.

Symptomatic key tooth to save for maxillary partial denture retention in an elderly patient. Canal calcifications, curved canals. Last post op shows a difficult casted post to make and fit for final cementation.

 

A tricky post removal and a previously omitted disto-lingual canal entry localised and treated with the help of a microscope (20X magnification). Ca(OH)2 was left in 4 canals for 10 days prior to final obturation. (Pulp Canal Sealer and lateral and vertical Gutta Percha condensation). Previous Zip in mesio-vestibular canal could not be bypassed despite extensive labor work. This distal canal falls into Vertucci’s type V canal configuration most probably due to its coronal preparation for a post.