Pobierz PDF - Dental and Medical Problems

Pobierz PDF - Dental and Medical Problems

clinical CASE
Dent. Med. Probl. 2013, 50, 3, 373–376
ISSN 1644-387X
© Copyright by Wroclaw Medical University
and Polish Dental Society
Katarzyna Barczak1, A, B, D, F, Jadwiga Buczkowska-Radlińska1, A, D, E
Root Canal Treatment of a Mandibular First Molar
with Five Root Canals – Case Report
Leczenie endodontyczne pierwszego zęba trzonowego żuchwy
z pięcioma kanałami – opis przypadku
1
Department of Conservative Dentistry, Pomeranian Medical University, Szczecin, Poland
A – concept, B – data collection, C – statistics, D – data interpretation, E – writing/editing the text,
F – compiling the bibliography
Abstract
A thorough diagnosis of the anatomy of the root canal system is a prerequisite for successful root canal treatment.
Observing the radiographs and examining of the pulp chamber floor help the location of root canal orifices. The
endodontic treatment of mandibular molars with aberrant canal configurations can be diagnostically and technically challenging. This case report presents the treatment of a mandibular first molar with five root canals, of
which three were located in the mesial root. The morphological pattern of separate apical terminations of three
mesial root canals with separate orifices as manifested in this case is very rare. Working-length of canals was
measured using apical locator which was confirmed radiographically. All canals were mechanically cleared to size
35 Hedstroem files and irrigated with 2% hypochlorite solution. After drying with standard paper points canals
were obturated with laterally condensed gutta-percha and AH-plus sealer. The Tooth were restored with composite
resin Herculite. After two-years recall clinically and radiography indicated positive result of treatment (Dent. Med.
Probl. 2013, 50, 3, 373–376).
Key words: mandibular first molar, root canal treatment.
Streszczenie
Dokładne poznanie anatomii systemu kanałów korzeniowych jest warunkiem powodzenia leczenia endodontycznego. Analiza zdjęć rentgenowskich oraz badanie dna komory pomagają zlokalizować ujścia kanałów korzeniowych. Leczenie endodontyczne zębów trzonowych żuchwy o nietypowej konfiguracji kanałów korzeniowych może
być trudne zarówno diagnostycznie, jak i klinicznie. W pracy opisano leczenie endodontyczne pierwszego zęba
trzonowego żuchwy z pięcioma kanałami, z których trzy były umiejscowione w korzeniach bliższych. Taki układ
morfologiczny pierwszego zęba trzonowego żuchwy z trzema oddzielnymi kananałami i oddzielnymi wierzchołkami w korzeniu bliższym jest rzadko spotykany. Długość roboczą kanałów określono enometrycznie i potwierdzono
radiologicznie. Kanały opracowano mechanicznie do rozmiaru narzędzia 35 i płukano 2% roztworem podchlorynu sodu. Do ostatecznego płukania zastosowano 15% EDTA. Po osuszeniu sączkami papierowymi kanały zostały wypełnione ćwiekami gutaperkowymi i uszczelniaczem AH plus metodą kondensacji bocznej. Następnie ząb
wypełniono materiałem Herculite. Badanie kontrolne kliniczne i radiologiczne po 2 latach potwierdziło pozytywny
wynik leczenia (Dent. Med. Probl. 2013, 50, 3, 373–376).
Słowa kluczowe: pierwszy trzonowy ząb żuchwy, leczenie endodontyczne.
Knowledge of the internal anatomy of teeth is
very important in planning and performing endodontic treatments. Normally, mandibular first molars have two roots; a mesial and distal one. The
usual canal distribution is two canals in the mesial root, and one in the distal root. Several case reports of patients with multiple canal systems in the
mandibular first molar have been published [1, 2].
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The probability of a mandibular first molar having a fifth canal is 1–15% [3]. Three canals in the
mesial and two in the distal root were found in
2.07% [4] and 3.4% [5], respectively.
Additional third canals in the mesial root
are situated centrally between the two main buccal and lingual root canals, and were described
as a middle mesial canal [2]. The diameter of the
third middle canals is smaller than that of the other two [6]. The third middle mesial canal is defined
as independent when a coronal orifice and apical
foramen are observed, or confluent when the two
main canals converge and terminate at a common
apical foramen [1].
This case report presents the treatment of
a mandibular first molar with five root canals, of
which three were located in the mesial root and
two in distal root. This tooth had three independent canals in the mesial root, a pattern that is seldom encountered.
K. Barczak, J. Buczkowska-Radlińska
and distolingual canals (type II Vertucci’s classification). An apical locator (Root ZX®, J. Morita,
Tokyo, Japan) and a no. 15 file were used to establish the length of the canal, which was confirmed
radiographically (Fig. 2).
All five canals were cleared with Hedstroem
files (Maillefer) to size 35 and irrigated with 2%
sodium hypochlorite solution. The final rinse for
each canal was performed with 2 ml of 15% EDTA. The canals were then dried with standard paper points and obturated with cold laterally condensed gutta-percha and AH plus sealer (DeTrey,
Dentsply, Switzerland) using size A and B spreaders (Maillefer®) (Fig. 3). A radiographic control
showed correctly obturated canals (Fig. 4–6). The
tooth was restored with light-cured composite resin Herculite® (Kerr, Scafati, Italy).
Case Report
A 26-year-old female was referred for endodontic therapy of her left mandibular first molar.
Partial pulp extirpation had been performed previously by another dentist, and a temporary filling placed. Radiographs showed no changes in the
apical region and no anatomical abnormality was
observed (one mesial and one distal root) (Fig. 1).
Adequate anesthesia was applied and, after rubber
dam placement, the temporary filling material was
removed. The canals were explored with size 15
H-files and K-files and five distinct orifices were
found; three mesially and two distally. Three independent canals with separate apical terminations
of the mesial root canals could be distinguished as
type VIII Vertucci’s classification [7]. In the distal root, there were two independent distobuccal
Fig. 2.Working-length radiograph. Five endodontic
instruments are inserted into the canals
Ryc. 2. Zdjęcie radiologiczne z pięcioma narzędziami
umieszczonymi w kanałach zęba
Fig. 1. Preoperative radiographs of the left mandibular
first molar
Fig. 3. Postoperative radiograph. The distal root canals
converge to a common apical termination
Ryc.1. Zdjęcie radiologiczne pierwszego zęba trzonowego żuchwy (36) przed leczeniem endodontycznym
Ryc. 3. Zdjęcie radiologiczne wykonane po wypełnieniu kanałów
Root Canal Treatment of a Mandibular First Molar with Five Root Canals
375
Fig. 4–6. Two-years recall radiograph indicating healthy periapical bone structure
Ryc. 4–6. Kontrolne RTG wykonane po 2 latach ukazuje prawidłową strukturę kości w okolicy wierzchołkowej
Discussion
General studies investigating the anatomy of
root canal systems and the anatomical variations
found in different types of teeth have provided information that might improve the outcome of endodontic treatments. An evaluation of the number
of roots and their morphology revealed that in
Thailand 87% of mandibular first molars had two
separate roots [5]. The frequency of two separate
roots in the Sudanese population was 78% [8].
In a study of 760 mandibular molars, FabraCampos [4] found that 2.6% had three canals in
the mesial root. The third canal ended as an independent canal in only one tooth (0.13%). In a sample of 118 first mandibular molars, Gulabivala et
al. [5] found two (1.9%) teeth with type VIII mesial
roots and five (4.8%) with type II distal roots. Cli-
nicians have shown a small number of treatments
of mandibular first molars with five canals [1, 9].
The search for an extra orifice is aided by the
use of magnifying loupes and operating microscopes, which help to provide enhanced visualization of the root canal intricacies and to locate the
canals, and help with cleaning and shaping. The
present case report shows that each case warranting root canal treatment should be carefully evaluated radiographically and clinically. Treating extra canals may be challenging, but the inability to
find and properly treat root canals may cause failures. It is important to report cases with unusual morphological canal configurations. This draws
the attention of the profession to their existence so
that similar cases may be better recognized and
successfully managed in the future.
References
[1]Holtzmann L.: Root canal treatment of a mandibular first molar with three mesial root canals. Int. Endod. J. 1997,
30, 422–423.
[2]Baugh D., Wallace J.: Middle mesial canal of the mandibular first molar: A case report and literature review. J. Endod. 2004, 30, 185–186.
[3]Navarro L.F., Luzi A., Garcia A.A., Garcia A.H.: Third canal in the mesial root of permanent mandibular first
molars: Review of literature and presentation of 3 clinical reports and 2 in vitro studies. Med. Oral Patol. Oral Cir.
Bucal 2007, 12, 605–609.
[4]Fabra-Campos H.: Unusual root anatomy of mandibular first molars. J. Endod. 1985, 11, 568–572.
[5]Gulabivala K., Opasanon A., NG Y.-L, & Alavi A.: Root and canal morphology of Thai mandibular molars. Int.
Endod. J. 2002, 35, 56–62.
[6]Martinez-Berna A., Badanelli P.: Mandibular first molar with six root canals. J. Endod. 1981, 8, 348–352.
[7]Vertucci F.J.: Root canal anatomy of the human permanent teeth. Oral Surg. Oral Med. Oral Pathol. 1984, 58,
589–599.
[8]Ahmed H.A., Abu-Bakr N.H., Yahia N.A., Ibrahim Y.E.: Canal morphology of Sudanese molar. Int. Endod. J. 2007, 40, 766–771.
[9]Barletta F.B., Dotto S.R., Reis M. de R., Forreira R., Coelho Travasso R.M.: Mandibular molar with five canals. Aust. Endod. J. 2008, 34, 129–132.
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K. Barczak, J. Buczkowska-Radlińska
Address for correspondence:
Katarzyna Barczak
Department of Conservative Dentistry
Pomeranian Medical University
Powstańców Wlkp. 72
70-111 Szczecin
Poland
Tel.: 91 466 16 48
E-mail: [email protected]
Received: 25.07.2013
Revised: 2.09.2013
Accepted: 16.09.2013
Praca wpłynęła do Redakcji: 25.07.2013 r.
Po recenzji: 2.09.2013 r.
Zaakceptowano do druku: 16.09.2013 r.