Canal In Maxillary First Molars Research Articles

Three Canals In The Mesiobuccal Root Of A Maxillary First Molar: A Case Report

This paper reports the case of a maxillary left first molar that presented three root canals in the mesiobuccal root. Treating extra canals in maxillary first molars may be challenging. Inability to find and properly treat the root canals may cause failures. Complete clinical and radiographic examination and a thorough knowledge of the morphology of these teeth are necessary for successful clinical results.

Six root canals in maxillary first molar

In this clinical article we report an unusual anatomy that was detected in a maxillary first molar with 6 root canals. The possibility of 6 root canals in this tooth is quite small; however, it must be taken into account in clinical and radiographic evaluation during endodontic treatment. Many times their presence is noticed only after canal treatment, owing to continuing postoperative discomfort.

Relationship between the size of patency file and apical extrusion of sodium hypochlorite

Sodium hypochlorite (NaOCl) is the most widely used endodontic irrigant because of its excellent antimicrobial, organic tissue dissolving, and lubricating properties. However, it is highly cytotoxic to the periapical tissues. This study evaluated in vitro the extrusion of 5.25% NaOCl through the apical foramina of mesiobuccal (MB) root canals of maxillary first molars in two experimental conditions: Before apical debridement and after apical debridement with different instrument sizes to ensure direct access to the apical foramen (apical patency). Coronal accesses were prepared in 17 teeth and the apical foramina of the distobuccal and palatal root canals were sealed. The teeth were held in acrylic receptacles with the roots turned upwards to reproduce their position in the maxillary dental arch. The receptacles were filled with a starch/KI solution (a reagent that changes its color to blue after contacting NaOCl) covering the roots. The experiment had two phases: P1: Irrigation of the MB canals with 5.25% NaOCl without previous establishment of apical patency; P2: Canal irrigation after use of size 10 K-file and size 15 Flexofile as patency files. Only specimens with no NaOCl extrusion in P1 were assigned to P2. NaOCl was delivered pressureless at the canal entrance. The moment that the starch/KI solution contacted NaOCl was captured on digital photographs. There was no NaOCl extrusion in nine specimens in P1, but all of these teeth had irrigant extrusion in P2. The 5.25% NaOCl used as an endodontic irrigant showed great capacity to extrude beyond both intact and small-sized apical foramina of MB root canals of maxillary first molars.

Cone-beam computed tomography analysis of the apical third of curved roots after mechanical preparation with different automated systems

The present study evaluated by cone-beam computed tomography (CBCT) the apical canal transportation and centralizing ability of different automated systems after root canal preparation. The mesiobuccal canals of maxillary first molars (n=10 per group) were prepared with: GI - reciprocating system with K-Flexofile; GII - reciprocating system with NiTiFlex files; GIII - rotary system with K3 instruments; GIV - rotary system with RaCe instruments. CBCT scans were taken before and after biomechanical preparation up to a #40.02 diameter. Canal transportation was determined by measuring the smallest distance between the inner canal walls and the mesial and distal sides of the root. The centralization ability corresponded to the difference between the measurements from transportation evaluation, using the linear voxel to voxel method of analysis. The mean transportation was 0.06 + or - 0.14 mm, with a tendency to deviate to the mesial side of the root (n=22), with no statistically significant difference among the groups (p=0.4153). The mean centralization index was 0.15 + or - 0.65 also without statistically significant difference among the groups (p=0.0881). It may be concluded that apical canal transportation and centralization ability were not influenced by the type of mechanical movement and instruments used.

Root and canal morphology of the mesiobuccal and distal roots of permanent first molars in a Kuwait population – a clinical study

To identify the number of roots and canal configurations in permanent first molars of the indigenous Kuwaiti sub-population and compare them against a similar group of non-Kuwaiti population in different age groups and gender, and to determine the frequency of a second canal in the mesiobuccal root of maxillary first molars and distal root of mandibular first molars that could be located and treated in routine practice without using magnification or special lighting conditions. A total of 220 permanent first molar teeth of patients scheduled for root canal treatment over a period of 1 year were included. Patients were identified and grouped according to their nationality as Kuwaiti and non-Kuwaiti (which included Filipinos, Indonesian Indians, Srilankans, Egyptians, Saudi Arabians and Syrians). In both nationality groups, patients were successively distributed into four groups based on their age. The first age group included patients below 20 years, the second 21-30 years, the third 31-40 years and the fourth were over 40 years. The first three groups comprised of 15 male and 15 female patients whilst the fourth group had 10 patients of each gender. Teeth with open apices, resorptions and calcification were excluded from the study. The teeth included were both clinically and radiographically examined for number of roots, the canal configuration and the presence of the additional mesiobuccal and distal canals and recorded. The simplified classification of canal configurations proposed by Weine was utilized. The incidence of a second canal in the mesiobuccal (MB) root of maxillary first molars and the distal root of mandibular first molars was not influenced significantly by nationality and gender. All the 110 maxillary first molars treated had three roots; 58% of MB root had one canal and 42% had two canals. The majority of the mesial roots had Weine type II canal configuration when the second mesiobuccal canal was present. All distobuccal and palatal roots had a single or type I canal configuration. Of the 110 mandibular first molars that were treated, 96% had two roots and 4% had three roots. When present, the third root was located either buccal or lingual to the main distal root. Overall 51% of the single distal roots had one canal whilst 49% had two canals. The mesial root frequently had a Weine type II canal configuration as did the distal root when a second canal was present. Pearson's correlation analysis of both molars revealed a significant (P < 0.05) negative correlation (r = -0.274, r = -0.144) between age and number of canals as well as the type of canal. The incidence of a second canal in distal roots of permanent mandibular first molars was 49% in the Kuwaiti population and this was similar to other Asian ethnic populations. Adopting modified access and troughing procedures revealed a 42% frequency of MB2 canals in maxillary first molars. The incidence of a second canal in both mesiobuccal roots of maxillary molars and distal roots of mandibular molars decreased significantly with age; no differences were noticed amongst the nationalities and gender studied. The possibility of extra roots should be anticipated in mandibular molars.

Anatomical features of the palatal root canal in maxillary first molars and their influence on endodontic procedure

Introduction: More detailed acquaintance with specialist endodontic literature and treating complicated endodontic cases have revealed that the palatal root canal in maxillary first molars has different features from generally accepted simplicity. Aim: The aim of this study was to investigate the number, orientation and shape of the curvature of the palatal root canal in maxillary first molars, characteristics that may have great influence on the procedure and outcome of endodontic therapy. Materials and methods: Material consisted of 100 left and 100 right extracted human first maxillary molars. Extended access cavity was prepared, and canal orifices were detected using an endodontic probe. K-flex file no 15 or 20 was then introduced into the palatal root canal until the tip appeared at the apical foramen. The tooth was radiographed from buccal-oral (clinical) and mesial-distal (proximal) aspect under standardized conditions. On magnified images, the number and character of canal, orientation and shape of the curvature were determined. Results: One palatal root canal was found in each of 200 teeth. From the clinical projection, 60% of the palatal canals appeared curved and from the proximal 93.5% (p&lt;0.05). Out of 120 curved canals from the clinical aspect, 66.7% were oriented distally and 33.3% mesially. From the proximal projection, of 187 curved canals 68,4% were oriented buccally, and 31,6% palatally. From the clinical projection, 49.2% were C-shaped, and 32.5 % with the J-shaped curvature. Only 18.3% of the palatal canals were with the S-shaped curvature (p&lt;0.05). Conclusions: Upon presented results, practitioners may predict with high significance the character, orientation and curvature shape of the palatal root canal in maxillary first molars in the buccal-oral dimension which is not visible on clinical radiographs and, therefore, perform more successful endodontic treatment.

Prevalence of Additional Canals in Maxillary First Molars in a Nigerian Population

The aim of this study was to investigate the prevalence of additional canals in maxillary first molars in a selected population in Nigeria. One hundred extracted teeth were collected from the Pedodontic and Oral Surgery clinics of the University College Hospital in Ibadan, Nigeria. The teeth were identified and their root planed to remove adherent soft tissues. Each tooth was sectioned at the cementoenamel junction (CEJ) and then again at 2 mm below the CEJ. The number of canals present in each root was noted. For the clinical aspect of the study, 30 patients with clinical and radiological evidence of pulpal involvement participated in the study. These patients had root canal therapy performed on their maxillary first molars and the number of canals was confirmed with periapical radiographs. In the laboratory phase of the study 77% of the teeth sectioned had three canals while 22% had four canals with the fourth canal being a second mesiobuccal canal. Only one tooth had five canals with two canals in the palatal root, two canals in the mesiobuccal root, and the remaining canal in the distobuccal root. For the clinical phase of the study, 29 (96.7%) out of 30 patients treated had three canals while only one (3.3%) had four canals with the fourth canal being a second mesiobuccal canal. Clinicians should assume there are additional canals in each root when performing endodontic therapy on the maxillary first molar. Only after a thorough search for extra canals and after it is determined further preparation would be fruitless or could cause perforation should the clinician proceed with treating only one canal per root. If root canal therapy fails, it may be due to the existence of an extra canal that was not located and treated in the first place. This should be considered carefully during re-treatment either by surgical or non-surgical methods.

An unusual maxillary first molar with four roots and six canals: a case report

This case report presents an unusual maxillary right first molar with four roots and six canals. Endodontic treatment was provided and final restoration was accomplished with composite resin. Treating extra canals in maxillary first molars may be challenging. Inability to find and properly treat the root canals may cause failures. Complete clinical and radiographic examination and a thorough knowledge of the morphology of these teeth is necessary for successful clinical results.

The incidence of four canals in maxillary first molars: A clinical determination

The authors conducted an in vivo study to report the incidence of fourth root canals located and treated in maxillary first molars during a seven-month period in a postgraduate endodontic program.In this retrospective study, the authors determined the number of canals treated by postgraduate students in an endodontic program. The attending postgraduate endodontic faculty member supervising the case verified the number of canals in the teeth. The authors then collected the data from each resident and compiled them.The residents treated a total of 121 maxillary molars, 85 (70.2 percent) of which met the criterion of having four or more canals treated. Approximately 99 percent of the fourth canals were located in the mesiobuccal root.Overall, 70 percent of the maxillary first molars contained at least four canals that required instrumentation.The results of this study demonstrate that it is imperative for any dentist performing root canal therapy on maxillary first molars to examine carefully the pulpal floor to locate all canals, especially the second mesiobuccal canal. Performing thorough examinations may increase the chance of treatment success.

Quantitative Three-Dimensional Analysis of Root Canal Curvature in Maxillary First Molars Using Micro-Computed Tomography

In endodontic therapy, access and instrumentation are strongly affected by root canal curvature. However, the few studies that have actually measured curvature are mostly from two-dimensional radiographs. The purpose of this study was to measure the three-dimensional (3D) canal curvature in maxillary first molars using micro-computed tomography (microCT) and mathematical modeling. Extracted maxillary first molars (46) were scanned by microCT (502 image slices/tooth, 1024X1024 pixels, voxel size of 19.5 × 19.5 × 39.0 μm) and their canals reconstructed by 3D modeling software. The intersection of major and minor axes in the canal space of each image slice were connected to create an imaginary central axis for each canal. The radius of curvature of the tangential circle was measured and inverted as a measure of curvature using custom-made mathematical modeling software. Root canal curvature was greatest in the apical third and least in the middle third for all canals. The greatest curvatures were in the mesiobuccal (MB) canal (0.76 ± 0.48 mm −1) with abrupt curves, and the least curvatures were in the palatal (P) canal (0.38 ± 0.34 mm −1) with a gradual curve. This study has measured the 3D curvature of root canals in maxillary first molars and reinforced the value of microCT with mathematical modeling.

A survey of endodontic practice amongst Flemish dentists.

The purpose of this study was to gather information on routine endodontic treatment performed by Flemish (Dutch-speaking Belgian) dentists. A postal questionnaire was sent to all the 4545 Dutch-speaking dentists registered in Belgium. The questionnaire was made up of 38 questions with multiple-choice answers. Results from 32 questions are presented, covering subjects, such as demographic and professional activity, root-canal preparation and instrumentation, emergency procedures and postoperative complications, choice of irrigants and disinfectants, and choice of obturation techniques. A total of 1143 questionnaires (25.1%) were returned. Approximately 94% of the respondents were general practitioners. The results indicate that there are discrepancies between daily practice and academic teaching, especially regarding the use of rubber dam (only 3.4% report using it as a standard procedure) and the detection and preparation of a second mesiobuccal canal in maxillary first molars (70% never or seldom). Most GDPs reported that they completed treatment in two visits. The majority of practitioners used manual instruments manipulated with a filing technique; 38.9% of the respondents prepared root canals 1 mm short of the radiographic apex. The most popular emergency procedure for acute pain was pulpectomy (40.2%); 48% performed pulpectomy, prescribed analgesics and antibiotics for acute apical periodontitis. Approximately 35% reported complications after cases with chronic apical periodontitis were treated. The first-choice root-canal irrigant was sodium hypochlorite and approximately 65% used intracanal medication. The most popular obturation technique was cold lateral condensation (60%) with 29% using AH26 as a sealer. A high proportion of GDPs (80%) performed re-treatments. The results of this study confirm that many Flemish general practitioners are not following quality guidelines for endodontic treatment.