Additional Canals Research Articles

Bilateral Paramolar Tubercles on the Distobuccal Surfaces of Mandibular Primary First Molars: A Rare Occurrence.

A 6-year old boy was seen at the Paediatric clinic in Bangalore, with the chief complaint of pain in the lower left primary second molar. His medical, surgical, and personal history was non-contributory. Extraoral examination revealed left submandibular lymphadenopathy. Oral examination revealed a large carious lesion in relation to the left mandibular second primary molar. No soft tissue abnormalities were found. On careful clinical examination, extra additional cuspal projections were seen on the distobuccal surfaces of the right and left mandibular primary first molars [Table/Fig-1]. The projections were 2x2mm in size with a globular shape and placed on the distobuccal surface of the mandibular primary first molars [Table/Fig-2]. [Table/Fig-1]: Intraoral view of the paramolar tubercle on distobuccal surface of the mandibular primary first molar [Table/Fig-2]: Mandibular cast showing the paramolar tubercles The opposing teeth conformed well in occlusion with these cuspal projections. No evidence of caries was noted in the grooves of these cusps. Neither the siblings nor the parents had reported with such abnormalities. The child was co-operative in the dental operatory. Pulpectomy was performed on 75, followed by placement of Stainless steel crown. Topical Fluoride application was performed was followed up periodically. Human teeth may show large variations in their morphological features and forms. Such changes may be found in the crown either in the form of anomalous cusps, or in an increased number of roots, these variations in the cusp number and number of roots are all termed as “Non metric dental traits” [1]. Three of the most commonly reported variations of accessory cusps are the Carrabelli cusps of the molars, Talon cusps of the incisors and Leong’s tubercle of the premolar seen commonly in permanent than primary dentition [2]. The term “paramolar tubercle” is used for any stylar anomalous cusp, supernumerary inclusion or eminence occurring on the buccal surfaces of both upper and lower premolars and molars. In 1916 Late Prof. L. Bolk of the Anatomical Institute of the University of Amsterdam described in literature for the first time, a rare entity known as the Protostylid. Protostylid is a supernumerary or accessory cusp found on the mesiobuccal surface of molars. In 1945, Dahlberg introduced a specific paleontologic nomenclature referring to this structure as “parastyle” when present in the upper molars and as “protostylid” when present in the lower molars. Though the aetiology is unknown, various studies have shown it occurs due to over activity of the dental lamina. It is now believed that PAX and MSX genes are responsible for the abnormal shape of the teeth. Due to their low overall occurrence, there is limited information regarding the frequencies among different races [3]. Paramolar tubercles provide an insight into dental evolution and development. These superstructures are potent sites for plaque retention. Recurrence of dental caries, gingival inflammation and localized periodontitis are often observed due to poor oral hygiene maintenance in these areas. The tubercle and an additional root canal can pose a challenge in endodontic therapy. The relation of the tubercular pulp and the main pulp has to be determined and when present in continuity, both have to be debrided thoroughly [4]. Thus early recognition of these anatomic variants is important so that preventive or restorative therapies can be instituted. Protostylids are the paramolar tubercles that are seen on the mesiobuccal surfaces of the teeth. They are very rarely seen bilaterally on the primary teeth. In the indexed case, we observed the bilateral occurrence of protostylids on distobuccal surfaces. This particular morphological trait is highly uncommon. The occurrence of the protostylid like entities on the distobuccal surfaces of the lower primary first molars as in this case will add to the literature available on the morphological variants of the primary first molars.

Endodontic management of hypertaurodontism

Taurodontism is a morphological developmental abnormality of a tooth in which the body of the tooth is enlarged at the expense of roots. The condition complicates nonsurgical root canal therapy because of the complexities within the root canal system, variable canal configurations, and expecting additional root canals. The present case report describes a case of bilateral hypertaurodontism and the endodontic therapy of right mandibular hypertaurodont second molar.

Mandibular Incisors with Type II Anatomy in a Single Patient: Report of Two Cases

Mandibular incisors are smallest teeth in the dentition. It is assumed that mandibular incisor is the most easy tooth to treat but sometimes these teeth are difficult to treat because of presence of extra canal which is present more lingually and often misdiagnosed and leads to treatment failure. Success of root canal treatment depends on careful diagnosis of additional canal and thorough debridement of root canal space and obtaining a fluid-tight seal. Thus, this article emphasis on careful management of mandibular incisors with the second canal (type II anatomy) in a single patient.

Aberrant canal configuration of the maxillary first molar

Aberrations in the root canal anatomy are a commonly occurring phenomenon. A thorough knowledge of the basic root canal anatomy and its variations is necessary for successful completion of the endodontic treatment. Maxillary first molars usually have three roots and three or four canals (two mesiobuccal canals, one distobuccal and one palatal canal). The incidence of two palatal canals in a palatal root is quite rare. This case provides an evidence of variations in the root canals in palatal root of maxillary first molar. Clinicians should thoroughly examine the pulpal floor and radiographs for the possibility of additional canals. The clinician must know not only the normal root canal anatomy but also variation from the normal. It is also paramount for the clinician to seek out every possible aberration of root canal anatomy for all teeth undergoing treatment.

Maxillary Lateral Incisor with Two Roots: A Case Report

Successful endodontic treatment of a tooth largely depends on proper diagnosis. Anatomical variations of a tooth are occasionally encountered and are challenging to diagnose and to manage as failure results due to the presence of untreated additional canals. This makes it imperative for the clinician to be able to identify the variation in the internal anatomy of the tooth being treated. We present the case of a permanent maxillary lateral incisor with unusual presentation of two roots which are dilacerated.

Tunneling Control of Optical Properties of a Quantum Well from Adjacent Quantum Well by Coherent Population Trapping Effect

Now the coherent population trapping (CPT) effect attracts a big researcher’s interest. The essence of this effect is the appearing of specific superposition of long-lived states in multilevel quantum system interacting with two-frequency coherent (usually laser) field. This superposition state (dark state) is not interacts with the field. The dark resonances were investigated theoretically [1, 2] as well as experimentally in semiconductor quantum wells in the basis of InGaAs/AlInAs and GaAs [3]. The dark resonances are of particular interest for the development of devices for recording and storing of quantum information and also for quantum logic elements. So the methods of recording and reading of qubits with a high degree of fidelity were realized on the basis of the EIT resonance in the atoms inside an optical lattice. In this work we investigate the CPT effect in the double tunnel-coupled quantum wells interacting with laser radiation 1,2,3  (Fig.1). The microwave field V closes the contour of excitation (-system). We found that it is possible to create the specific collapse of population (dark resonance), which takes place for the excited level of simple -system, for the ground level 3 of additional excitation canal. Moreover, destruction and restoration of CPT by variation of the total phase Ф (Fig.1) of exciting fields in the -system gives us the possibility to control population of the ground level 3 . We investigate the cases of constant and pulsed optical radiation. In the case of pulsed radiation we found that only edges of signal pulse are absorbed. Middle of the pulse does not interact with the quantum wells due to dark state of the level 3 . It can be useful for reducing of the pulse duration and generation of the higher harmonics. This work is supported by Russian President grant for young candidates of sciences (project МК-384.2013.2), non-profit foundation Dynasty, Russian Foundation for Basic Research (project 14-02-31422), Regional Public Science Support Foundation, British Petroleum company, State Assignment for universities 2014/184.

Root canal morphology analysis of maxillary permanent first and second molars in a southeastern Turkish population using cone-beam computed tomography

Background/purposeThe aim of this retrospective study was to determine the root and canal morphology of the maxillary first and second molars in a Turkish subpopulation using cone-beam computed tomography (CBCT). Materials and methodsCBCT images of 417 women and 410 men aged 14–70 years were examined. A total of 1158 maxillary permanent first molars and 1305 maxillary permanent second molars were analyzed. The number of root canals and canal configurations were investigated and classified according to Vertucci's classification. The data were analyzed using Pearson's Chi-square test. ResultsIn both first and second maxillary molars, the presence of three roots was the most common occurrence. The prevalence of additional canals (type II, III, or greater) in mesiobuccal roots of maxillary first and second molars was approximately 62% and 37.5%, respectively. Type I canal configuration was the most prevalent in the distobuccal (99.6%) and palatal (99.8%) roots of maxillary first molars, and in the distobuccal (99.7%) and palatal (99.2%) roots of maxillary second molars. The incidence of the number of root canals and the configurations of maxillary first and second molars did not statistically differ with sex (P > 0.05). ConclusionThe high prevalence of additional canals in the mesiobuccal roots of maxillary first and second molars is noteworthy. CBCT is an effective method to study the external and internal morphology of dental tissues.

Cone-beam computed tomography evaluation of maxillary first and second molars in Iranian population: a morphological study.

The aim of this in vitro study was to identify the root and canal morphology of maxillary first and second molars in Iranian population by taking and analyzing cone-beam computed tomography (CBCT) scans. Extracted maxillary first (n=125) and second (n=125) molars were collected from native Iranians and scanned by using a CBCT scanner. The number of roots and configuration of root canal system were classified according to Vertucci's classification. Two (1.6%) maxillary first and two (1.6%) maxillary second molars had four roots. Prevalence of root fusion was 2.4% and 8.8% in maxillary first and second molars, respectively. The most common canal morphology in the mesiobuccal roots of three-rooted first and second molars was type I (46.4% and 80.8%, respectively), followed by type VI (17.6%) in first molars. The predominant morphology of distobuccal and palatal roots in first and second molars was type I. Additional canal types were also identified. Profound knowledge of anatomic variations is necessary prior to cleaning and obturation of the root canal system. The most common discovered root morphology was three separate roots in both tooth types. The greatest variation in canal anatomy was discovered in the MB canals of both the first and second molars.

Evaluation of the root and canal morphology of mandibular permanent molars in a south-eastern Turkish population using cone-beam computed tomography.

Objective:The aim of this retrospective study was to determine the root and canal morphology of the mandibular first and second permanent molars in a Turkish population using cone-beam computed tomography (CBCT).Materials and Methods:CBCT images of mandibular first (n = 966) and second molar (n = 1165) teeth from 850 Turkish patients were evaluated. The root canal configurations were classified according to the method of Vertucci. The data were analyzed by Pearson's Chi-square test.Results:The majority of mandibular molars were two rooted with three canals; however, three roots were identified in 0.05% of the first molars and 0.01% of the second molars, and 100% of the additional root canals were of type I configuration. Mesial roots had more complex canal systems with more than one canal, whereas most distal roots had a type I configuration.Conclusions:Within the limitations of this study, it can be concluded that CBCT scanning provides supplemental information about the root canal configurations of mandibular molars in a Turkish population. This study may help clinicians in the root canal treatment of mandibular molars.

Evaluation of Root and Canal Morphology of Maxillary Permanent First Molars in a North American Population by Cone-beam Computed Tomography

IntroductionThe purpose of this study was to evaluate the number of roots and canal morphology of maxillary permanent first molars in a North American population. MethodsThree hundred seventeen cases with bilateral maxillary first molars were included. All images from cone-beam computed tomography were carefully reviewed by 2 endodontists. Frequency of number of roots, presence of an additional mesiobuccal canal (MB2), and Vertucci canal type for each root were tabulated. Age, gender, and ethnicity differences were calculated with the χ2 test. The intra-rater reliability was assessed by using the Cohen kappa statistic. ResultsThe fused root rate was 0.9%. The occurrence of 3-rooted maxillary first molars differed between left and right sides (P = .03). MB2 occurrence only showed statistically significant differences among age groups (P = .005). In the mesiobuccal roots, the most common Vertucci classifications of canal types were type IV (2-2, 41.9%), type I (1, 28.3%), and type II (2-1, 26.3%). There was a statistically significant difference in Vertucci classification of canal type among 5 ethnic groups (African American, Asian, Hispanic, Other, and Non-Hispanic white, P < .001). ConclusionsCone-beam computed tomography facilitates the identification of root and canal configuration. The information gained about the tooth anatomy and canal morphology before treatment could potentially facilitate root canal therapy.

English

AIM-To diagnose radix paramolaris with the aid of spiral CT which often gets misdiagnosed in routine radiographic imaging to increase success rate of root canal treatment. SUMMARY: An additional mesio-buccal root, the radix paramolaris is major anatomical variant of the two rooted mandibular first molar. Awareness and understanding of this unusual root morphology contributes to the success of root canal therapy. This case report provides insight into the endodontic management of mandibular molar with radix paramolaris, with the aid of spiral computer tomography. The canals were shaped with hand protaper files and irrigated with 5.25% sodium hyochlorite, 0.2 %w/v of chlorhexidinegluconate and normal saline as the final irrigant. The canals were then obturated with gutta- percha and AH plus sealer. This case report shows an anatomic variation of internal morphology of the tooth and points out the importance of searching for additional canals and roots.

Five canalled and three-rooted primary second mandibular molar.

A thorough knowledge of root canal anatomy and its variation is necessary for successful completion of root canal procedures. Morphological variations such as additional root canals in human deciduous dentition are rare. A mandibular second primary molar with more than four canals is an interesting example of anatomic variations, especially when three of these canals are located in the distal root. This case shows a rare anatomic configuration and points out the importance of looking for additional canals.

Re-treatment of a Two-rooted Maxillary Central Incisor - A Case Report

This case report is on endodontic retreatment of a maxillary central incisor with two roots. A twenty-year-old male patient presented with pain in maxillary left central incisor. Radiographic examination showed an incompletely filled canal and an additional palatal root with periapical radiolucent lesion. Conventional cleaning and shaping of both the roots, i.e., buccal and additional palatal root canals was performed and obturation was done. After one year recall examination, the tooth was asymptomatic and periapical lesion had healed.

An endodontic management of mandibular third molar with five root canals

The existence of several anatomical variations in the root canal system may contribute to failure of the root canal therapy. The planning and performing of endodontic therapy requires knowledge of the internal dental morphology. This paper reports the case of a left mandibular third molar that presented with five root canals; a case of unusual root canal morphology so as to demonstrate the anatomic variations in mandibular third molars. Root canal therapy and case management are described. This report highlights the importance of looking for additional roots and root canals so as to enable clinicians to treat a case successfully, which might have ended in failure.

Endodontic management of maxillary molar with six root canals - a case report

The aim of the present case report is to describe the unusual root canal anatomy of maxillary first molar with six canals, three in mesiobuccal root, two in distobuccal root and one in palatal root. This article highlights the importance of modifying the access opening and magnification in location of the additional canal orifices.

Mandibular molar with six canals: Report of cases

A mandibular molar with more than four canals is an interesting example of anatomic variations. This case report describes a mandibular first molar with six canals, three canals located in the mesial root and three canals in distal root. The canals were instrumented with rotary system and irrigated with NaOCl (5.25%) and normal saline as the final irrigant. The canals were filled with gutta-percha (Denstply, Maillefer, Switzerland) and AH-plus sealer (Dentsply DeTrey GmbH Konstanz, Germany). This case shows a rare anatomic configuration and points out the importance of search for additional canals.

Analysis of Root Canal Anatomy &amp; Morphological Variations of Maxillary 1st Molar by Different Methods - An In Vitro Study

Background: Successful endodontic treatment involves accurate diagnosis, good understanding of the biological principles and excellent execution of the treatment. To execute an excellent treatment, it’s imperative that the clinician has comprehensive knowledge of the root canal anatomy and then know-how to locate and treat this anatomy. Objective: To analyze the internal anatomy of the maxillary first molar, to report the incidence of fourth root canals by comparing the efficacy of three diagnostic methods, Operating microscope, Cone beam computerized tomography and clearing technique. Material methods: A sample size of 126 sound non carious, intact human maxillary 1st molar were taken for the study and were divided into three groups according of method of analysis of root canal system-(Group 1: operating microscope, Group 2: Cone beam computerized tomography, Group 3:clearing technique). Anatomical variation in form of additional canal in mesiobuccal root was analyzed for total incidence. Results: For statistical analysis, Mean and Standard deviation were calculated for each group by using chi square test which revealed statistically significant difference between group 2 and 3 and non-significant difference between group 1 and group 2.

A COMPARATIVE STUDY OF MICROLEAKAGE OF OBTURATED ROOT CANALS AFTER DISINFECTION WITH Nd:YAG LASER, PDT AND NAOCL AND EDTA.

SUMMARY Endodontic therapy consists of cleaning and shaping the root canal system, removing organic debris and sealing the intracanal space with permanent filling materials. The use of lasers and photo-activated disinfection in endodontic treatment may cause morphological changes in the dentin of the root canal. The purpose of this laboratory study was to compare the degree of hermetic obturation of root canals after endodontic treatment and disinfection with Nd: YAG laser, photo-activated disinfection with FotoSan, NaOCL 2,5% + EDTA 17% and obturated with AH 26 sealer and guttapercha. For the laboratory study we used 30 freshly extracted single rooted teeth. After that the teeth are divided into three groups, depending on the mode of additional root canal disinfection and obturated. The leakage was shown using dye penetration test with methylene blue for a period of 3 days at 37°C. Microleakage was observed in all studied groups.

Dental microscope in Nonsurgical Endodontics

Modern endodontics has essentially changed following the introduction of the dental microscope since 1990's. One of main advantage of using dental microscope in nonsurgical endodontic treatment is enhancing clinician's ability and quality of treatment through illumination and magnification. Scopes of dental microscope in nonsurgical endodontics are finding a missed or additional root canal and a tooth crack, management of procedural errors, and others. These improvements in technology will result in greater confidence in treatment and better success in clinical practice.

MODERN CONCEPTS OF ETIOLOGY, PATHOGENESIS AND TREATMENT APPROACHES TO ENDO-PERIO LESIONS

A combination ofperiodontitis and pulp or periapical tissues inflammation in one tooth is known as endo-periodontal lesions. Such kind of lesion is serious problem of modern dentistry. It was found that pathogenic microflora of periodontal pocket and root canal of tooth with eno-perio lesion is almost the equal and consist of anaerobic microorganisms. Pathogenic effects have not only microorganisms but also their life products. Apical foramen, lateral and additional canals are physiological ways for pathogens migration. Inflammatory processes in these structures complicate each other. Lack of information among dentists about treatment possibilities of endo-perio lesions is a main reasons of extraction such kind of teeth. Simultaneous elimination of pathogens both from periodontal pocket and root canal is a key factor for effective treatment. Periodontal status is main factor for prognosis of tooth with endo-perio lesion, because of it treatment of endo-perio lesions should consist of two stages: infection elimination and regeneration of tooth-supported structures.