Documente Academic
Documente Profesional
Documente Cultură
Abstracto
El Primer molar superior por lo general tiene tres races a saber,
mesiovestibular, distovestibular, y palatina. La incidencia de cuatro canales en
primeros intervalos molares maxilares del 50,4% al 95%, el quinto canal es de
2,25%, y algunos autores han descrito casos con seis y siete canales
tambin. Con este nmero variable de canales y configuraciones de canal, el
tratamiento endodntico de los primeros molares superiores es siempre un
reto. En este artculo se describe clnica de un caso de un primer molar
superior con la anatoma inusual de cinco canales de la raz y su manejo
endodntico.
Palabras clave: configuracin de canal, canales adicionales, primer molar,
raz
anatoma
del
canal,
las
variaciones
Introduccin
Reporte de un caso
Discusin
Conclusin
apoyo
financiero
patrocinio
Nulo.
Conflictos
No
de
hay
conflictos
inters
de
inters.
referencias
1. Buhrley LJ, Barrows MJ, Bgole EA, Wenckus CS. Efecto de la ampliacin
en la localizacin del conducto MB2 en los molares superiores. J endod
2002; 28: 324-7.
2. Piedra LH, troner WF. molares superiores que muestran ms de un canal
de la raz palatina. Oral Surg Oral Med Oral Pathol 1981; 51: 649-52.
3. Aggarwal V, Singla M, Logani A, Shah N. gestin de endodoncia de un
primer molar superior con dos canales de paladar con la ayuda de la
tomografa computarizada espiral: Presentacin de un caso. J endod
2009; 35: 137-9.
4. Karthikeyan K, Mahalaxmi S. Nueva nomenclatura para los canales
adicionales en base a cuatro casos reportados de primeros molares
superiores con seis canales. J endod 2010; 36: 1073-8.
5. Ahmad IA, Al-Jadaa A. Tres tratamientos de conducto en la raz
mesiovestibular de los molares superiores: Los informes de casos y
revisin de la literatura. J endod 2014; 40: 2087-94.
6. Neelakantan P, Subbarao C, R Ahuja, Subbarao CV, Gutmann JL. De haz
cnico calcula estudio de la tomografa de la raz y la morfologa del canal
de primeros y segundos molares maxilares en una poblacin india. J endod
2010; 36: 1622-7.
7. Baratto Filho F, S Zaitter, Haragushiku GA, de Campos EA, Abuabara A,
Correr GM. El anlisis de la anatoma interna de los primeros molares
maxilares mediante el uso de diferentes mtodos. J endod 2009; 35: 33742.
8. Weller RN, Hartwell GR. El impacto de las tcnicas de acceso y de
bsqueda mejoradas en la deteccin del canal mesiolingual en los molares
superiores. J Endod 1989; 15: 82-3.
9. Cleghorn BM, Christie WH, Dong CC. Raz y la morfologa del conducto
radicular de la humana permanente primer molar superior: Una revisin de
la literatura. J endod 2006; 32: 813-21.
CASE REPORT
Year : 2016 | Volume : 7 | Issue : 1 | Page : 45-47
Correspondence Address :
Sekar Mahalaxmi
Department of Conservative Dentistry and Endodontics, SRM Dental College, Chennai - 600 089, Tamil Nadu
India
DOI : 10.4103/0976-433X.176477
Abstract
Maxillary first molar usually has three roots namely, mesiobuccal, distobuccal, and
palatal. The incidence of four canals in maxillary first molar ranges from 50.4% to 95%,
the fifth canal is 2.25%, and few authors have reported cases with six and seven canals
too. With this varying number of canals and canal configurations, endodontic treatment
of the maxillary first molars is always a challenge. This clinical article describes a case
report of a maxillary first molar with the unusual anatomy of five root canals and its
endodontic management.
Keywords: Canal configuration, extra canals, maxillary first molar, root canal
anatomy, variations
Introduction
the complex anatomy of their roots and root canals. One of the major causes of root
canal failure is the inability to identify, locate, and treat the entire root canal system.
Variations in the number and configuration of the roots and their canals have been
reported in the literature over the years; the most common variation being the presence
of a second mesiobuccal canal with incidence of more than 90%. [1] Even the rarely
found two palatal canals have also been reported. [2] , [3] The increasing reports of more
than one mesiobuccal canal and additional distobuccal canals in the recent years can be
attributed to the increased knowledge of the root canal complex morphology, advanced
diagnostic tools such as cone-beam computed tomography (CBCT) and microcomputed tomography and using equipment such as dental operating microscope,
ultrasonics,
and
specialized
instruments.
Since naming these extra canals was still elusive, a new nomenclature was suggested for
ease of communication. [4] The occurrence of more number of canals in the mesiobuccal
(MB) root may be due to the broad bucco-palatal dimensions of the root. [5] The
incidence of more than one canal in the distobuccal root has been reported to be more
than 6%. [6] When performing endodontic treatment, the clinician should always assume
the presence and look for signs of these variations. A thorough knowledge of root canal
morphology and the use of magnification increase the chance of successful clinical
results.
This case report discusses one such variation in the maxillary first molar; the detection
of five canals, and the successful completion of its endodontic treatment with a one year
follow-up.
Case Report
A 40-year-old male patient reported to the dental clinic with the complaint of pain in the
left upper back tooth region. On clinical examination, a deep carious lesion was found
in the left maxillary first molar; the nature of pain being continuous, dull and radiating
to the left side of the head. The patient had pain on palpation and
percussion. Radiographic examination revealed caries approximating the pulp with
periapical radiolucency present along the apex of mesial root [Figure 1] a. Vitality test
revealed early response to a cold test that lingered even after removal of the
stimulus. The case was diagnosed as symptomatic irreversible pulpitis with
symptomatic apical periodontitis in tooth no. 14. Hence, root canal treatment followed
by postendodontic full coverage restoration was planned.
Figure 1: (a) Preoperative radiograph, (b) The floor of pulp
chamber showing 2 mesiobuccal, 2 distobuccal (DB) and 1
palatal (P) canal orifices, (c) Master cone radiograph, and (d)
Photograph
of
obturated
canals
Under local anesthesia (2% lignox, 1:80000 adrenaline), conventional access cavity
preparation was done with Dentsply India Pvt. Ltd, India (to reach the pulp
chamber). Extension and de-roofing of the pulp chamber were done to provide straight
line access to the canals.Coronal pulp was removed. The three principal canals namely
mesiobuccal, distobuccal, and palatal canals were identified. Small hemorrhagic spots
were identified palatally to both mesiobuccal and distobuccal canals. The conventional
triangular access was modified to a trapezoidal shape to improve the access. Five canals
were located in the floor of the pulp chamber, namely two mesiobuccal, two distobuccal
and
one
palatal [Figure
1] b.
Canal negotiation and glide path was established with a no 10 K file (Mani Inc.,
Tochigi, Japan) using Ethylenediaminetetraacetic acid (EDTA) gel (Endo Prep RC,
Anabond Stedman Pharma Research Ltd., Tamil Nadu, India) as a lubricant. Working
length determination was done using electronic apex locator Root ZX mini (J. Morita
Mfg. Corp., Kyoto, Japan). Initially, canals were prepared with hand instruments up to
size 20 K file. Coronal third enlargement and middle third shaping of the canals was
done using 6% rotary instruments 30, 25, 20, size (Hero Shapers, Micro Mega, SA,
France) and apical third enlargement done using 4% rotary instruments 20, 25, and 30
size. The final preparation was 30 size and 6% taper for the palatal canal and 30-4% for
other four canals. Sodium hypochlorite 3% solution was used as an irrigant throughout
the shaping procedure. Final rinse was done with 2 ml of 17% EDTA solution
(DESMEAR, Anabond Stedman Pharma Research Ltd., Tamil Nadu, India).
Obturation was done using 30-4% Gutta-percha points and 30-6% Gutta-percha points,
by warm vertical condensation done using hot pluggers [Figure 1] c and [Figure
1] d. Access cavity was restored using composite resin material. The patient was
recalled for the crown.Follow-up evaluations at 6 months and 1-year were done.
Discussion
The success of endodontic treatment largely depends upon the identification, shaping,
cleaning, and obturation of the complex root canal system. It is known that maxillary
first molar has one of the most complex root canal morphology [Figure 2] . Baratto
Filho et al . have shown that the use of a dental operating microscope and CBCT
clinically enhances the ability to identify and locate extra canals. [7]
Figure 2: Micro-computed tomography of root canal anatomy
of maxillary first molars; note the variations and complexities
of
the
root
canal
system. Image
courtesy:http://rootcanalanatomy.blogspot.com
This case report emphasizes the importance of the use of magnification for exploring
the canals and modification of access cavity to ensure the proper endodontic
treatment. Weller and Hartwell showed that modification of the access cavity from a
conventional triangular to rhomboidal shape, exploration of the groove running from the
MB to palatal and removal of any projections that may conceal the canal orifice
enhances
the
chances
of
locating
the
additional
MB
canals. [8]
According to the literature, the occurrence of the fourth canal in maxillary first molar
ranges greatly. A literature review by Cleghorn et al .on the root and root canal
morphology states that incidence of two canals in the MB root was higher in laboratory
studies (60.5%) compared to the clinical studies (54.7%). [9] Less variations were
reported in distobuccal and palatal roots. In recent years, this percentage has been
alarmingly on the rise, mainly due to advanced diagnostic technics with enhanced
anatomical knowledge and the operator's keenness in detecting these variations. Clinical
studies have always shown a higher prevalence of the second canal in the MB and
distobuccal
roots. [7] , [9]
It can thus be safely concluded that adequate knowledge and experience, and the use of
suitable diagnostic adjuncts helps in enhancing the success of endodontic treatment of
maxillary
first
molars.
Conclusion
This case report contributes to our understanding of root canal morphology found in a
maxillary first molar. Hence, dentists performing endodontic treatment in maxillary first
molars should always assume more number of canals and complex canal systems unless
proven otherwise.
We would like to thank Dr. Marco Versiani, Brazil for granting permission to use an
image from their website. We also thank Dr. K. Karthikeyan for helping us with the
editing of the manuscript.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
1.
2.
3.
Buhrley LJ, Barrows MJ, BeGole EA, Wenckus CS. Effect of magnification on
locating the MB2 canal in maxillary molars. J Endod 2002;28:324-7.
Stone LH, Stroner WF. Maxillary molars demonstrating more than one palatal root
canal. Oral Surg Oral Med Oral Pathol 1981;51:649-52.
Aggarwal V, Singla M, Logani A, Shah N. Endodontic management of a maxillary
first molar with two palatal canals with the aid of spiral computed tomography: A
case report. J Endod 2009; 35:137-9.
4.
5.
6.
7.
8.
9.