Endodontic management of a maxillary first molar with a single root and a single canal diagnosed with the aid of spiral CT: a case report

A Rare Occurrence of Bilateral Single-Rooted Mandibular First Molar

It is essential to have an in-depth knowledge of root and root canal anatomy to prevent any iatrogenic errors. Many studies and case reports are present in the literature related to the anatomy of mandibular first molars, but most of them are on an extra number of roots and root canals. There are few studies related to a lower number of roots and root canals, but the occurrence of bilateral mandibular first and second molars with the presence of root fusion resulting in a single root is very rare. This case report presents the nonsurgical endodontic management of the left and right mandibular first molars with the presence of a single root confirmed using a CBCT and treated by placing an apical MTA plug followed by backfill using thermoplasticised gutta percha.

Endodontic management of maxillary first molar with unusual anatomy

This article reports nonsurgical endodontic management of bilateral maxillary first molars with an unusual morphology of a single root and a Sert and Bayirli type-IX canal configuration. A 41-year-old female reported with dull continuous pain in the maxillary left and right quadrants. On clinical examination, the maxillary first molars on both sides were carious with pulpal exposure and radiographic evaluation revealed an unusual anatomy of single root and single canal for both of them. Based on clinical and radiographic examination, tooth numbers 16 and 26 were diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis. Root canal treatment was initiated and cone-beam computed tomography (CBCT) imaging was advised on encountering unusual internal anatomy. The CBCT images revealed the presence single root and a Sert and Bayirli type-IX canal configuration bilaterally. Root canal treatment was performed under magnification using the dental operating microscope.

Endodontic management of the maxillary first molars with two root canals: A case report and review of the literature

BACKGROUND

The complex anatomy of the maxillary first molars has always been a major challenge for complete root canal treatment in endodontic therapy. Here, we present two cases of maxillary first molars, each with only two root canals, which have been rarely reported. We also perform a literature review of maxillary first molar anatomy.

CASE SUMMARY

The two patients were referred to the hospital after 1) finding a cavity in their tooth with a color change and, 2) a toothache during mastication, respectively. Both of these cases were diagnosed as apical periodontitis by X-ray imaging and cone beam computed tomography (CBCT). Non-surgical endodontic therapy was performed with the assistance of a dental operating microscope (DOM). CBCT showed rare but accurate images of both patients, each with two root canals and two roots in their maxillary first molars. Both roots were located in the buccal in the palatal direction, and each root had only one clear root canal. In addition, each maxillary first molar in both patients was symmetrical to that on the opposing side with only two separate root canals. Non-surgical endodontic therapy was performed with the assistance of a DOM. Finally, the teeth were restored using composite resin and the patients were satisfied with the results.

CONCLUSION

Making full use of CBCT and DOM would contribute to helping dentists make correct diagnoses and successfully treat teeth with rare root canal morphologies.

Management of a permanent maxillary first molar with unusual crown and root anatomy: a case report

The aim of this article was to showcase the endodontic management of a maxillary first molar with an unusual crown and root anatomy. Clinical diagnosis of the roots and root canal configuration was confirmed by a cone-beam computed tomography (CBCT) and the detection of the canals was made using a dental operating microscope. CBCT images revealed the presence of 5 roots with Vertucci type I canal configuration in all, except, in the middle root which had 2 canals with type IV configuration. The 6 canal orifices were clinically visualized under the dental operating microscope. Clinicians should familiarize themselves with the latest technologies to get additional information in endodontic practice in order to enhance the outcomes of endodontic therapy.

The use of spiral CT in the detection and management of a permanent maxillary first molar with single root and single canal: A rare occurrence

A sound knowledge of the normal tooth morphology and its numerous variations is essential to the success of endodontic therapy. While extra canals and lateral canals are routinely encountered and documented, there also exists the rare possibility of a fewer number of canals than normal. Early detection of such an occurrence is critical to the prevention of iatrogenic errors during endodontic treatment. The advent of spiral CT as a diagnostic tool serves as a much needed confirmation to understand the complex three dimensional anatomy of teeth. The aim of this case report is to highlight one such case reporting unusual morphology of the permanent maxillary first molar displaying single canal and single root, and the role of spiral CT in its detection and management. Key words:Permanent maxillary first molar, root canal anatomy, single root, single canal, Spiral CT.

Volumetric Evaluation of Different Obturation Techniques in Primary Teeth Using Spiral Computed Tomography

BACKGROUND

Various obturation techniques have been evaluated for better filling of the root canals in primary teeth using different methods. Spiral Computed Tomography (SCT) is a new revolution in the pediatric endodontics for assessment of quality of the obturation from 3 dimensions.

OBJECTIVES

To evaluate the efficiency of 5 different obturation methods in delivering the filling material into the canals of primary teeth using Spiral Computed Tomography scan.

STUDY DESIGN

A total of 50 canals of primary teeth were prepared, divided into 5 groups with 10 canals in each group and obturated with Zinc Oxide Eugenol cement using 5 different obturation techniques such as Local anesthetic syringe, Tuberculin syringe, Endodontic plugger, hand held Lentulo-spiral, and Lentulo-spiral mounted on slow speed hand piece. The pre and post obturation volume and finally the Percentage of Obturated Volume (POV) were calculated using SCT scan for each group. The data obtained was statistically analyzed using One-way Analysis of Variance (ANOVA) and Tukey's post-hoc test.

RESULTS

Lentulo-spiral hand held showed highest POV value followed by Lentulospiral mounted to hand piece, Tuberculin syringe and Endodontic plugger; whereas Anesthetic syringe had least POV (P < 0.05).

CONCLUSION

Lentulo-spiral hand held is the best obturating technique among the 5 groups evaluated as the canals of this group showed maximum percentage of filled material. However, a further study with large sample size is highly essential.

CBCT-based Diagnosis of Periapical Lesion of Maxillary First Premolar Mimicking That of Second Premolar

Apical periodontitis is usually diagnosed based on clinical findings and dental X-rays. Recently, however, dental cone beam computed tomography (CBCT), which provides 3-D images of the maxillofacial region, has enabled dentists to examine patients undergoing endodontic therapy more effectively, improving diagnostic accuracy. Here, we describe a positive treatment outcome achieved using CBCT to diagnose apical periodontitis of the maxillary premolars, which had proven difficult to diagnose based on clinical findings and dental radiography alone. The patient was a 42-year-old Japanese man who presented with the chief complaint of gingival swelling in the maxillary right premolar region. Our initial diagnosis, based on clinical findings and dental X-ray, was apical periodontitis of the maxillary right second premolar, and treatment was started. However, after the patient failed to respond to the treatment, CBCT was performed. Based on these new findings, the diagnosis was changed to one of apical periodontitis of the upper right first premolar, and the patient was treated accordingly. Previous studies have described the complex anatomical morphology of the upper premolars, noting multiple roots and variation in the morphology of the root canals. The 3-D images provided by dental CBCT allow better assessment of oral conditions than the traditional 2-D images provided by dental X-rays, which in turn enables the dentist to better select the most appropriate treatment. Here, the patient showed no symptoms and was progressing well at a 6-month follow-up visit. The present results indicate that when clinical findings and dental X-rays alone are insufficient to allow a secure diagnosis, CBCT offers an effective alternative which will enable the appropriate treatment to be selected more reliably.

Radix mesiolingualis and radix distolingualis: a case report of a tooth with an unusual morphology

Variation in the root and canal morphology of the maxillary first molars is quite common. The most common configuration is 3 roots and 3 or 4 canals. Nonetheless, other possibilities still exist. The presence of an additional palatal root is rather uncommon and has been reported to have an incidence of 0.06 - 1.6% in varying populations studied. Whenever two palatal roots exist, one of them is the normal palatal root, the other is a supernumerary structure which can be located either mesiolingually (radix mesiolingualis) or distolingually (radix distolingualis). This case report describes successful endodontic treatment of a maxillary first molar with radix mesiolingualis and radix distolingualis. Identification of this variation was done through clinical examination along with the aid of multiangled radiographs, and an accurate assessment of this morphology was made with the help of a cone-beam computed tomography imaging. In addition to the literature review, this article also discusses the epidemiology, classifications, morphometric features, guidelines for diagnosis, and endodontic management of a maxillary first molar with extra-palatal root.

Computed tomography: Will the slices reveal the truth

With the advances in the field of imaging sciences, new methods have been developed in dental radiology. These include digital radiography, density analyzing methods, cone beam computed tomography (CBCT), magnetic resonance imaging, ultrasound, and nuclear imaging techniques, which provide high-resolution detailed images of oral structures. The current review aims to critically elaborate the use of CBCT in endodontics.

Analysis of the Root and Canal Morphologies in Maxillary First and Second Molars in a Chinese Population Using Cone-beam Computed Tomography

INTRODUCTION

We analyzed and characterized the root and canal morphologies in maxillary first and second molars in a large sample of Chinese patients using reconstructed cone-beam computed tomographic (CBCT) imaging.

METHODS

Maxillary first (n = 1558) and second (n = 1539) molars were collected from Chinese patients (N = 844) who had undergone in vivo CBCT imaging. The root canal number and morphology were determined according to Vertucci's classification.

RESULTS

A single root was found in 0.06% of first molars, which showed type I canal systems. However, second molars with a single root (4.2%) showed widely varied canal systems. The buccal roots of first molars with 2 separate roots showed type I, II, or III canal systems, whereas those of 2-rooted second molars showed widely varied canal systems. The incidence of fused roots was 1.38% for first molars and 23.9% for second molars, whereas canal fusion within fused roots was observed in 4.5% of first molars and 10.6% of second molars. Additional canals were observed in 67.8% and 29.7% of mesiobuccal roots, 1.8% and 0.7% of distobuccal roots, and 0.7% and 0.3% of palatal roots in 1523 and 1017 first and second molars with 3 separate roots, respectively. The mesiobuccal root canal number showed bilateral symmetry between 79% of first molars and 82.3% of second molars, with a concurrence rate of 59.8% between adjacent molars.

CONCLUSIONS

We reported the root and canal morphologic variations in maxillary first and second molars, which have not been reported for Chinese populations. Further studies should focus on canals in fused roots and mesiobuccal roots.

Complicated canal morphology of mandibular first premolar

The aim of this article was to report an unusual anatomic variation of mandibular first premolar, with one root and three distinct canals, which leave pulp chamber and merge short of apex to exit as two separate apical foramina. The incidence of three canals existing as two apical foramina has only been documented in the literature by a few case reports. To achieve successful endodontic treatment, the clinician has to identify the different canal configurations and treat them properly.

Management of a maxillary first molar having atypical anatomy of two roots diagnosed using cone beam computed tomography

Most often, a clinician working on maxillary first molar when anticipates an aberration thinks of an extra canal but rarely does he preempt fewer canals. Maxillary first molar is a tooth, which has been extensively reviewed with respect to its external and internal morphology. Abundant literature related to its anatomy is available, but reports on incidence of two roots and two root canals in maxillary first molar are very limited. Here, a case of maxillary first molar is presented that had two roots: one palatal root with Type I canal configuration and one bulbous fused buccal root with Type V canal configuration; a unique root and canal configuration not seen in any of the earlier reported cases. Diagnosis of root canal aberrancy and subsequently, accurate management of the tooth was greatly facilitated by cone beam computed tomography (CBCT) scan. The relevance of CBCT in improving treatment prognosis is greatly emphasized in this report.

A comparative evaluation of the canal centering ability of three rotary nickel-titanium retreatment systems in the mesio-buccal canals of mandibular first molars using computed tomography

Background:

During endodontic retreatment, relative difficulty exists in removing the filling material and maintaining the canal anatomy. Usage of nickel-titanium (NiTi) rotary retreatment instruments is widely accepted, but there is a lack of adequate literature evidence about their canal centering ability.

Aim:

To compare the canal centering ability of rotary NiTi retreatment systems.

Materials and Methods:

Mandibular first molars with mesiobuccal canals with canal access angle of 20-40° were used. Canals prepared until ISO 25, 0.06 taper. Obturated with three different techniques lateral compaction, Thermafil, and Resilon/Epiphany. Retreatment was carried using three different systems ProTaper retreatment, Mtwo R and REndo. Specimens were subjected to computed tomography analysis at coronal, middle, and apical third of the root canal preobturation and postretreatment procedure.

Statistical Analysis Used:

One-way ANOVA and post-hoc Tukey test.

Results:

No statistically significant difference with three retreatment systems. Variation existed among all the subgroups at the coronal, middle, and apical third of the root canal.

Conclusion:

All retreatment systems with three obturation techniques showed eccentricity within acceptable limits. REndo, MtwoR showed better canal centering and ProTaper retreatment system showed tendency for eccentric canal preparation, especially in apical third.

Mandibular first molar with single root and single root canal

Mandibular molars demonstrate considerable anatomic complexities and abnormalities with respect to number of roots and root canals. Clinicians should be aware that there is a possibility of the existence of a fewer number of roots and root canals than the normal root canal anatomy. Mandibular first molar with a single root and single canal was diagnosed with the aid of dental operating microscope and multiple angled radiographs. This case report presents a rare case of successful endodontic management of mandibular first molar with a single root and root canal.

Single C-shaped canal in mandibular first molar: A case report

The variability of root canal system morphology presents a continuous challenge to endodontic diagnosis and therapeutics. There have been reports of teeth with multiple roots and canals as also those with lesser number of root and root canals. Variations of root canal systems need not always be in the form of extra canals. Clinicians should be aware that there is a possibility of existence of fewer numbers of roots and root canals than normal, which presents varied canal anatomy and poses a challenge to the clinician's expertise. This case report deals with the management of an unusual case of C-shaped canal in mandibular molar with two buccally fused roots. Cone-beam computed tomography (CBCT) was employed to confirm the extension of the unusual anatomy. The Self Adjusting File (SAF) system was used to ensure complete cleaning of the canal system. One-year follow-up of the case showed good healing. The clinician should expect to encounter unusual features when performing endodontic treatment. Use of diagnostic aids like CBCT, improved magnification with dental operating microscope, and the use of novel file systems like SAF ensure success.

Endodontic management of a maxillary molar with formation supradentalis: A case report

Anatomic variations may be observed in the crown or in the roots of maxillary molars. In rare instances, crown and root morphology, both show variations. Occurrence of paramolar cusp on the occlusal surface as central cusp or on the buccal surface as parastyle has been frequently reported in maxillary molars. However, presence of paramolar cusp on the palatal surface has not been reported. 'Formation supradentalis' is a condition in which supernumerary cusp is associated with a supernumerary root in a molar. The occurrence of such concomitant corono-radicular morphology is multifactorial, that is primary polygenic with secondary environmental influences. This case reports the diagnosis and endodontic management of Formation-supradentalis that had six cusps and four roots in the maxillary first molar. The tooth exhibited a prominent paramolar palatal cusp and cusp of Carabelli along with a supernumerary palatal root. To the best of author's knowledge, this is the first documentation of endodontic management of Formation supradentalis.

Root canal treatment of a two-rooted C-shaped maxillary first molar: a case report

The most difficult maxillary teeth for endodontic treatment are the maxillary first molars (MFM) due to their complex root canal anatomy. The presence of two roots and C-shaped canals in MFMs has been reported in rare cases. The present case reports root canal treatment of MFM with two roots, where the palatal and buccal roots were joined together in a C-shaped configuration.

Mandibular first molar with a single root and single canal

Successful endodontic management of mandibular first molar with a single root and single canal is diagnosed with the aid of dental operating microscope and multiple angled radiographs. In addition all the mandibular molars and premolars were single rooted on either side.

A comparative assessment of fracture resistance of endodontically treated and re-treated teeth: An in vitro study

Aim:

To compare and assess the fracture resistance of endodontically treated teeth with those that have been subjected to endodontic retreatment.

Materials and Methods:

30 extracted mandibular premolars were decoronated at cementoenamel junction and randomly divided into 2 groups. In Group I endodontic treatment was performed with ProTaper rotary system till size F2 and obturated. In Group II, cleaning and shaping was done and teeth were subjected to Spiral CT to assess the remaining dentin thickness and obturated. Later retreatment was done using Protaper Universal Retreatment system and final shaping was performed till size F3. Remaining dentin thickness was again assessed using Spiral CT and then obturated. All the specimens were subjected to fracture resistance using universal testing machine. The results were statistically analyzed using Independent Samples t-test for analysis of remaining dentin thickness using SCT within Group II and Paired Samples t-test was used for assessment of fracture resistance between Group I and II (P < 0.05).

Results:

In Group II, the intra group comparison of the remaining dentin thickness in the coronal third reveals statistical significance, with a significant difference noted in the apical third. Results of the fracture resistance reveal a statistically significant difference (P < 0.05) between Groups I and II with the mean fracture resistance of Group I being higher than Group II.

Conclusion:

Endodontically retreated teeth have shown significantly decreased resistance to fracture and this has a positive correlation to the increased loss of root dentin during the retreatment procedures

Mandibular second molar with a single root and a single canal: case series

The variability of root canal system morphology of multirooted teeth represents a continuous challenge to endodontic diagnosis and therapeutics. This report extends the range of known possible anatomical variations to include teeth with lesser number of root and root canals. Variations of root canal systems need not always be in the form of extra canals. Clinicians should be aware that there is a possibility of existence of fewer number of roots and root canals than the normal root canal anatomy. Thus the aim of this article is to present three cases of endodontically managed mandibular second molars with a single root and root canal.

A rare root canal configuration of bilateral maxillary first molar with 7 root canals diagnosed using cone-beam computed tomographic scanning: a case report

INTRODUCTION

The complexity of the root canal system of maxillary molars presents a constant challenge in the diagnosis and treatment of these teeth. This case report describes the importance of a surgical operating microscope and cone-beam computed tomographic (CBCT) imaging.

METHODS

Root canal treatment of a left maxillary first molar with 3 roots and 7 canals was successfully performed. Seven canals were identified with the help of a surgical operating microscope and CBCT imaging. CBCT images also confirmed the 3 roots and 7 canals in the right maxillary first molar.

RESULTS

CBCT images confirmed a type IV canal pattern in the distal and palatal root, whereas the mesial root had a type VIII canal pattern.

CONCLUSIONS

The use of a surgical operating microscope and CBCT imaging helps the clinician to diagnose unusual anatomy of a tooth and facilitate successful endodontic treatment.

C-shaped maxillary permanent first molar: a case report and literature review

INTRODUCTION

The C-shaped configuration is rare in the upper first molar.The purpose of this article is to present 2 cases diagnosed during endodontic therapy and perform a literature review of this anatomy in the upper first molar.

METHODS

Endodontic therapy was performed by using a dental operating microscope and a cone-beam computed tomography analysis for better understanding of this anatomy. A literature search was conducted to identify and compare all the published cases of C-shaped upper first molar.

RESULTS

Before the cases reported in this article, only 5 cases were available in the published literature. Three different types of C-shaped configurations in the upper first molar have been presented.

CONCLUSIONS

The C-shaped maxillary first molar is a rare anatomic configuration. The use of the dental operating microscope may help in the endodontic therapy of these cases. Three types of C-shaped configurations have been reported; the fusion of the distobuccal root with the palatal root appears to be the most usual one.

Type I canal configuration in a single rooted maxillary first molar diagnosed with an aid of cone beam computed tomographic technique: A rare case report

Anatomic variations in maxillary molars are frequent. These deviations are also one of the major cause for endodontic treatment failure owing to inadequate cleaning, shaping and sealing of root canal system. Diagnosis of such aberrations using newer imaging techniques like cone beam computed tomography is firmly advocated. The present paper highlights the root canal treatment of a rare case of type I canal morphology diagnosed with an aid of cone beam computed tomographic technique.

Spiral computed tomographic evaluation and endodontic management of a maxillary canine with two canals

Aberrations in the root canal system can pose a considerable challenge to the endodontist during root canal treatment. These anatomical variations are more commonly seen in maxillary molars and mandibular teeth, but only a few cases have been reported with alteration in the internal canal anatomy of maxillary canine. The present report describes the diagnosis of bilateral occurrence of two root canals in maxillary canines with single root and the endodontic management of the right maxillary canine with the aid of spiral computed tomography (CT). The CT images revealed the presence of Vertucci's type-III canal configuration in the right maxillary canine. The same canal pattern was found in the contra-lateral canine, which was absolutely healthy; and also all the mandibular anterior teeth and first premolars showed bifid canal pattern.

Asyndromic hypodontia associated with tooth morphology alteration: A rare case report

Clinicians frequently encounter hypodontia in their practice. It can be associated with any syndrome or more commonly it is asyndromic. This asyndromic form is commonly familial and can be followed in heredity of the patient. The patient referred in this report presented with a rare anomaly of hypodontia with altered morphology where the patient had all the teeth single rooted and single canalled. Studies have indicated several genes that affect the tooth morphology and number. A genetic correlation of hypodontia with altered permanent teeth morphology may be explored further in studies.

Use of cone-beam computed tomography to evaluate root and canal morphology of mandibular first and second molars in Turkish individuals

Objective: The aim of this study was to investigate the root and canal morphology of mandibular first and second molars in a Turkish population by using cone beam computed tomography (CBCT). Study design: CBCT images of mandibular first (n = 823) and second molar (n = 925) teeth from 605 Turkish patients were analyzed. The root canal configurations were classified according to the method of Vertucci. Results: The majority of mandibular molars (95.8% of first molars, 85.4% of second molars) had two separate roots; however, three roots were identified in 2.06% of first molars and 3.45% of second molars. C-shaped canals occurred 0.85% of first molars and 4.1% of second molars. Three canals were found in 79.9% of first molars and 72.8% of second molars. Most distal roots had a simple type I configuration, whereas mesial roots had more complex canal systems, with more than one canal. The most common root morphology of first and second molars is the two rooted morphology with three canals. Both the mesial and distal roots showed wide variations in canal anatomy with type IV and type I canal configuration predominating in the mesial and distal roots, respectively. Conclusion: Vertucci type I and IV canal configurations were the most prevalent in the distal and mesial roots, respectively, of both the mandibular first and second permanent molar teeth.

Key words:Cone-beam CT, Turkish, mandibular molars, root and canal morphology.

Maxillary first molar with two root canals

Knowledge regarding the anatomic morphology of maxillary molars is absolutely essential for the success of endodontic treatment. The morphology of the permanent maxillary first molar has been reviewed extensively; however, the presence of two canals in a two-rooted maxillary first molar has rarely been reported in studies describing tooth and root canal anatomies. This case report presents a patient with a maxillary first molar with two roots and two root canals, who was referred to the Department of Endodontics, Tabriz University of Medical Sciences, Iran.

Two-rooted maxillary first molars with two canals: a case series

Thorough understanding of the anatomic and internal morphology of a root canal system is absolutely essential for the success of endodontic treatment. Since permanent maxillary first molars have shown variation in internal anatomy, morphology, this tooth has been reviewed extensively. Presence of two canals in a two-rooted maxillary first molar has rarely been reported in studies describing tooth and root canal anatomies. In this report, three cases are presented, which involve the root canal treatment of maxillary first molars with fusion of the two buccal roots.

Spiral computed tomographic evaluation and endodontic management of a mandibular second molar with four roots. A case report and literature review

The vast majority of mandibular second molars have two roots with three root canals; however, variations in molar root canal anatomy are not uncommon. To the best of our knowledge, four rooted mandibular second molar with three mesial roots and one distal root has never been reported. Herein, we present the endodontic management of a four rooted mandibular second molar tooth, diagnosed with the assistance of spiral computed tomography (SCT) with a brief review of literature.

Endodontic management of two-rooted mandibular premolars using spiral computed tomography: a report of two cases

AIM

To present a unique case of mandibular first and second premolars with two roots and two root canals with the aid of spiral computed tomography (SCT).

BACKGROUND

Confirmation of morphology of mandibular first and second premolars with the aid of SCT.

CASE DESCRIPTION

Mandibular premolars usually have a single root and a single canal. The occurrence of two roots with two separate root canals is extremely rare. The use of SCT in this rare case greatly contributed toward making a confirmatory diagnosis and successful endodontic management.

CONCLUSION

Successful nonsurgical endodontic management of mandibular first and second premolars with two separate roots and root canals has been presented. In this case, exact root canal anatomy could not be confirmed by using radiographs alone. Hence, the use of SCT helped us in making a confirmatory diagnosis.

CLINICAL SIGNIFICANCE

Developmental anomalies can occur in any tooth and two rooted premolars are no exception. The complexity of such teeth has to be considered for planning endodontic treatment using latest diagnostic equipment to increase the chances of success.

Imaging techniques in endodontics: an overview

This review provides an overview of the relevance of imaging techniques such as, computed tomography, cone beam computed tomography, and ultrasound, to endodontic practice. Many limitations of the conventional radiographic techniques have been overcome by the newer methods. Advantages and disadvantages of various imaging techniques in endodontic practice are also discussed.

Maxillary first molar with two palatal roots located under dental operating microscope

An awareness and understanding of the presence of an additional root and unusual root canal morphology is essential as it determines the successful outcome of endodontic treatment. A thorough knowledge of basic root canal anatomy and its variation is necessary for successful completion of endodontic treatment. This report points to the importance of looking for additional roots and canals with the help of operating microscope. Finding additional roots and canals would enable clinician to successfully treat a case that would otherwise not be successful.

A new anatomically based nomenclature for the roots and root canals-part 1: maxillary molars

Numerous terminologies have been employed in the dental literature to describe the roots and root canal systems of maxillary molars. This multiplicity in naming of roots and canals makes the reader susceptible to misinterpretation and confusion. No consensus thus far has been arrived at for defining the names of roots and root canals in maxillary molars, including their various morphological aberrations. The anatomical relation of roots and their root canals were identified and were subsequently named based on definite sets of criteria. A new method for identification and naming of roots and root canal anatomy in maxillary molars, based on their root and canal relationship, was formulated and is presented in this paper. The nomenclature makes certain essential modifications to the traditional approach to accommodate naming of the various aberrations presented in the maxillary molars. A simple, yet extensive, nomenclature system has been proposed that appropriately names the internal and external morphology of maxillary molars.

Three-dimensional helical computed tomographic evaluation of three obturation techniques: In vitro study

AIM

The purpose of this study was to evaluate the adequacy of three obturation techniques namely lateral condensation, EQ Fil (backfill obturation) and thermafil (core carrier obturation) techniques using three-dimensional (3D) helical computed tomography (CT) by volume rendering method.

MATERIALS AND METHODS

Thirty freshly extracted teeth were randomly divided into three groups of 10 teeth each. Biomechanical preparation was done in all the teeth using rotary instruments. All three sets of teeth were placed in helical CT slice scanner and were imaged before obturation. The three sets were then obturated by following methods: Group I: lateral condensation, Group II: EQ Fil (backfill) and Group III: thermafil (core carrier obturation).Volume of the pulp chamber and gutta-percha after obturation were calculated using volume rendering technique and adequacy of the obturation techniques were calculated.

STATISTICAL ANALYSIS USED

One-way ANOVA and Multiple-Range Tukey Test by Tukey-HSD procedure

RESULTS

Mean change in lateral condensation (0.005±0.002) was significantly higher than that of thermafil obturation (0.002±0.001) [P<0.05].

CONCLUSIONS

Conventional lateral condensation technique showed maximal inadequacy of obturation and thermafil obturation technique showed the least inadequacy of obturation when the volume of the specimens were calculated and reconstructed.

Endodontic management of a maxillary first molar with eight root canal systems evaluated using cone-beam computed tomography scanning: a case report

INTRODUCTION

Root canal treatment of maxillary molars presenting with complex root canal configurations can be diagnostically and technically challenging.

METHODS

Nonsurgical endodontic therapy of a left maxillary first molar with three roots and eight root canals was successfully performed. This unusual morphology was diagnosed using a dental operating microscope (DOM) and confirmed with the help of cone-beam computed tomography (CBCT) images.

RESULTS

CBCT axial images showed that both the mesiobuccal and distobuccal root contained a Sert and Bayirli type XV canal, whereas the palatal root showed a Vertucci type II canal configuration.

CONCLUSIONS

The use of a DOM and CBCT imaging in endodontically challenging cases can facilitate a better understanding of the complex root canal anatomy, which ultimately enables the clinician to explore the root canal system and clean, shape, and obturate it more efficiently.

Utilizing spiral computerized tomography during the removal of a fractured endodontic instrument lying beyond the apical foramen

AIM

To present a case that used spiral computerized tomography (CT) to locate and successfully remove a fractured endodontic instrument lying beyond the apical foramen using a surgical approach.

SUMMARY

The fracture of an endodontic instrument beyond the apical foramen is rare. In this case report, after an attempt to remove a fractured instrument failed, a multi-slice spiral computerized tomography (MSCT) was used for diagnosis and treatment planning. The fractured segment was precisely located and found in the soft tissue and successfully removed by surgery. For the successful removal of a fractured endodontic instrument beyond the apical foramen, the following are necessary: (i) knowledge of the cause of fracture and how to plan treatment; (ii) determining the precise location of the fractured segment using CT; and 3) skilful operation.

KEY LEARNING POINTS

•  Fractured endodontic instruments might lie within the soft tissue. •  Computerized tomography is an effective diagnostic aid for localizing the precise position of fractured instruments.

Endodontic management of maxillary permanent first molar with 6 root canals: 3 case reports

This article discusses the successful endodontic management of 3 permanent maxillary first molars presenting with the anatomical variation of 3 roots and 6 root canals. A literature review pertaining to the variable root canal morphology of the permanent maxillary first molar is also presented. Modifications in the root canal access preparation and methods for examination of the pulpal floor with the aid of magnification for identification of additional canals are emphasized.

Maxillary first molar with seven root canals diagnosed with cone-beam computed tomography scanning: a case report

INTRODUCTION

The purpose of this article was to emphasize the importance of having a thorough knowledge about the root canal anatomy.

METHODS

This case report presents the endodontic management of a maxillary first molar with three roots and seven canals. The clinical detection of the seven canals was made using a surgical operating microscope and confirmed using cone-beam computed tomography (CBCT) scanning.

RESULTS

CBCT axial images showed that both the palatal and distobuccal root have a Vertucci type II canal pattern, whereas the mesiobuccal root showed a Sert and Bayirli type XV canal configuration.

CONCLUSION

This report describes and discusses the variation in canal morphology of maxillary first molar and the use of latest adjuncts in successfully diagnosing and negotiating them.

Management of a patient with a taurodont, single-rooted molars associated with multiple dental anomalies: a spiral computerized tomography evaluation

Anomalies, though rare, are potential restorative and endodontic challenges. This case report presents a unique case with a bizarre combination of anomalies, including single conical unbifurcated posterior root forms, taurodontism, dens invaginatus, prominent labial lobes of the canines, pyramidal cusps of the premolars, dens evaginatii of the molar crowns, and localized reduction in tooth size involving the entire dentition without any other apparent systemic complication. On literature review, only 4 such cases were found to be reported. An accurate assessment of the presence of single conical unbifurcated posterior root forms was made with the help of spiral computerized tomography. This case report highlights the use of high-end diagnostic imaging modalities such as spiral computerized tomography in making a confirmatory diagnosis of the multiple morphologic abnormalities.