Palatal Canals Research Articles

Maxillary First Molars with Two Palatal Root Canals

Understanding the anatomical variations in the roots and root canal systems of a tooth is important for the success of root canal treatment. The palatal roots of the maxillary molars have fewer anatomical variations than the other roots, and fewer variations occur in the first molars than in the second molars. This case report describes two distinct cases of maxillary first molars with two palatal canals. For the root canal treatment of teeth with anatomical variations, it is essential to plan specific treatment strategies using cone-beam computed tomography and to execute them using a dental operating microscope. Knowledge of the anatomical variations in the palatal roots of maxillary first molars will help to increase the success rate of root canal treatments.

Comparison of Obturation Quality after MTA Orthograde Filling with Various Obturation Techniques.

This study aimed to quantify and compare the obturation quality after mineral trioxide aggregate (MTA) orthograde fillings with three different obturation techniques. Thirty-three extracted human maxillary molars were collected. Distobuccal and palatal canals were prepared to an apical size of #40/06 with a Profile Ni-Ti system. All 66 canals were divided into two groups according to the material (EZ-seal or OrthoMTA) and then obturated using three different techniques: manual compaction using S-kondenser (group H), compactor activation (group C), or reverse rotary motion of Ni-Ti file (group R). The obturated roots were scanned using micro-computed tomography (micro-CT). The percentage of voids located in the apical 5 mm was measured separately, that is, closed, open, and total porosity. There was no relation between the filling material and obturation technique (p > 0.05). The percentage volume of open and total porosity was higher in EZ-seal than in OrthoMTA (open: p = 0.002, total: p = 0.001). Group H showed higher open and total porosity than groups C and R. Micro-CT analysis showed that the void volume after orthograde MTA fillings significantly decreased when the additional activation was accompanied by hand condensation. Obturation with a Ni-Ti file using reverse motion could be recommended as an MTA orthograde filling technique.

Endodontic Management of the Maxillary First Molar with Two Palatal Canals: A Case Report

ABSTRACT The major goals of root canal treatment are to remove irritants from the root canal system, fill or obturate the cleaned and shaped system, and prevent future recontamination of sealed root canals. However, endodontic treatment is also dependent on having sound knowledge of the internal anatomy of human teeth, especially when anatomic variations are present, clinicians should carefully explore the pulpal floor, further by changing the X-ray projection angle to confirm the existence of variation and prevent the missed canals, all of which are necessary for a successful root canal therapy. These clinical case reports present the application of cone-beam computed tomography as a useful imaging technique in endodontics for the management of teeth with aberrant anatomy. How to cite this article: Jharwal A, Raisingani D, Mital P, et al. Endodontic Management of the Maxillary First Molar with Two Palatal Canals: A Case Report. J Mahatma Gandhi Univ Med Sci Tech 2020;5(2):61–65.

The Efficacy of Reciproc Blue® For Canal Cleanliness Following the Retreatment of Maxillary First Molar: In Vitro Analysis

Nonsurgical retreatment involves removing mechanical barriers such as gutta-percha to achieve proper cleaning and disinfection. The complexity of the anatomy of molar tooth gives challenge in retreatment procedure. Thus, this study evaluates the amount of residual gutta-percha after retreatment with rotary files (Reciproc Blue®) from each maxillary first molar canal using cone-beam computed tomography (CBCT) and the time required to accomplish it. Nine freshly extracted maxillary molars were instrumented and obturated. Preoperative CBCT was taken, and retreatment was done using Reciproc Blue®. CBCT was taken post retreatment, and the residual volume percentage of gutta-percha from each canal was calculated. The total retreatment time was recorded, and the data were statistically analyzed. The result shows no statistically significant difference in the amount of residual filling material in mesiobuccal, distobuccal, and palatal canal for maxillary first molar and total time used for retreatment with Reciproc Blue® system.

Maxillary first molar endodontic management with seven root canals diagnosed using CBCT: A case study

The main objective of this case study is to present an unusual maxillary first molar root canal configuration with seven root canals; three mesiobuccal, two distobuccal and two palatal canals diagnosed during treatment procedure confirmed by Cone Beam Computed Tomography. A 26-year-old man with the chief complaint of spontaneous pain in his left posterior maxilla was referred to by his general dentist. From the clinical and radiographic results, a diagnosis of apical periodontitis was made and the patient was recommended for endodontic care. The CBCT axial images of the patient showed that the palatal and distobuccal roots have a type IV and type II canal pattern of Vertucci, respectively, while the mesiobuccal root showed a type XV canal configuration of Sert and Bayirli. Canals have been successfully treated with rotary files and filled using a single-cone technique. In endodontically difficult situations, the use of CBCT imaging will promote a deeper understanding of the intricate root canal anatomy, which essentially helps the clinician to more effectively explore the root canal system and clean, shape, and obturate it. Keywords: Cone Beam Computed Tomography, Maxillary first molar, Root canal anatomy, Seven root canals.

Maxillary Canine with two roots and two canals: A case report

Introduction: Knowledge of the anatomy and root canal system is of fundamental importance for a successful endodontic treatment. Maxillary canines unusually possess two root canals. Aim: The present study aims to present a maxillary canine with two roots and two canals through a clinical case. Case report: A male patient was referred for the treatment of a root perforation of the tooth 23. Clinical examination revealed the presence of vestibular fistula and mild pain with vertical and horizontal percussion. Through a tomographic examination, the presence of two roots and two root canals was observed in addition to a radiolucent lesion at the middle third of the roots but without perforation in the middle third. Coronary opening and the localization of the vestibular and palatal canals were performed. The root canal length was performed with Romi Apex A-15® foraminal locator and instrumentation was conducted by using Protaper Next® system. Due to the presence of fistula, calcium hydroxide manipulated with propylene glycol was used as intracanal medication for 30 days. After this period, the root canals were filled with gutta-percha and AH Plus® cement and a new tomographic examination was undertaken, which confirmed the complete filling of the root canals and the absence of root perforation. Conclusion: Given the above, endodontic professionals shall be aware of possible anatomical variations and make use of auxiliary resources when appropriate, such as cone beam computed tomography (CBCT), to ensure correct diagnosis and, consequently, a successful root canal treatment.

Maxillary Second Molar with a Rare Palatal Root Canal Morphology: A Case Report

ABSTRACT Knowledge of the root canal anatomy and its variations is essential for successful completion of the endodontic treatment. Root canal treatment of maxillary second molars with aberrant canal configuration can be challenging. The incidence of two palatal canals in a palatal root is quite rare in maxillary molars. The novel diagnostic aids such as cone-beam computed tomography (CBCT) help in the successful management of such cases. This case report describes the successful diagnosis and treatment of a maxillary second molar with two palatal canals, merging at the apical third of the root. How to cite this article: Sen P, Prasad AB, Mital P, et al. Maxillary Second Molar with a Rare Palatal Root Canal Morphology: A Case Report. J Mahatma Gandhi Univ Med Sci Tech 2020;5(1):23–25.

Mesiobuccal and Palatal Interorifice Distance May Predict the Presence of the Second Mesiobuccal Canal in Maxillary Second Molars with Fused Roots

IntroductionThe aim of this study was to evaluate if the configuration of canal orifices can predict the presence of a second mesiobuccal canal (MB2) in maxillary second molars with fused roots. MethodsMaxillary second molars with fused roots (N = 150) were scanned in a micro–computed tomographic device (pixel size = 9 μm) and evaluated regarding the root fusion type and the incidence of the MB2 canal. The centers of the canal orifices were connected, and the angles formed by the intersection of these lines as well as their distances were measured and statistically compared (1-way analysis of variance). Specimens were then assigned to 2 groups according to the presence (n = 65) or absence (n = 50) of the MB2 canal and compared regarding the angles and interorifice distances using the Welch t test. A binary logistic regression model estimated the association between the interorifice distance, the fusion type, and the presence of the MB2 canal, whereas receiver operating characteristic curve analysis was performed to evaluate the diagnostic abilities of significant variables. The significance level was set at 5%. ResultsThe most common fusion types were 1 and 6, and MB2 canal incidence was 47.3%. No statistical difference was observed in the angles or interorifice distances among teeth with different fusion types (P > .05). Distances from the mesiobuccal (MB) to the distobuccal and palatal (P) canal orifices as well as the MB and P angles were significantly higher in the presence of an MB2 canal (P < .05). A binary logistic regression model revealed that MB-distobuccal and MB-P distances were significant in the presence of an MB2 canal (P < .05). Receiver operating characteristic analysis indicated that MB-P distance had acceptable diagnostic accuracy for the prediction of MB2 canal presence. Sensitivity (specificity) calculated from the MB-P distances of 4.0, 4.5, and 5.0 mm were 89.2% (36.5%), 76.9% (58.4%), and 44.4% (71.4%), respectively. ConclusionsMB-P interorifice distance is a strong predictor of the presence of the MB2 canal in maxillary second molars with fused roots.

Comparative evaluation of fracture resistance of endodontically treated premolars with one remaining cavity wall restored using different techniques and materials: An in vitro study

Introduction: This study was aimed to evaluate and compare the effectiveness of conventional posterior composites, and short fiber-reinforced composites with and without the use of glass fiber post (GFP) and polyethylene fiber post on fracture strength of endodontically treated maxillary premolar teeth. Materials and Methods: Root canal treatment was performed on the sixty extracted maxillary premolars followed by mesio-occluso-distal cavity preparation and removal of the lingual wall. The teeth were randomized into six groups (A1, A2, A3; B1, B2, and B3). In Group A, a conventional posterior composite was used as a core material, and in Group B, short fiber-reinforced composite was used. Groups A and B were divided according to the post systems used. In Groups A1 and B1, 3 mm deep cavities were prepared in the palatal canal and restored with respective core materials. In Groups A2 and B2 GFP were placed in 10 mm post space prepared in the palatal canal and restored with respective core material. While in Groups A3 and B3 polyethylene, fiber post was placed, followed by core build-up with respective core materials. Samples were subjected to fracture resistance testing in the Universal testing machine, and the fractured samples were inspected in stereomicroscope under 20× for identifying fracture patterns. The data were analyzed using one-way ANOVA, followed by post hoc Tukey's test. The failure pattern was analyzed using the Chi-square test. Results: Higher fracture resistance values were seen with groups restored with the post as compared to groups restored without post, but the difference was not statistically significant (P > 0.05). The short fiber-reinforced composite showed higher resistance values than the conventional composite (P 0.05). The use of post resulted in a significantly higher number of favorable fracture of the teeth (P Conclusion: The use of post did not have a profound effect on the fracture resistance but had a positive effect on failure patterns in teeth with one remaining wall. In root canal treated teeth with one wall remaining, the use of either post with short fiber reinforced composite is recommended.

Management of Bilateral Maxillary Second Molars with Extra Palatal Root: A Case Report

A crucial understanding of teeth’ internal and external anatomy is critical for the successful outcome of endodontic therapy. The presence of two palatal roots in maxillary molars, particularly in the second molar is rare. The present case report addresses this anatomical variation in an 18-year-old female patient with a chief complaint of severe pain in the upper left back teeth region since one week. Preoperative radiographic evaluation of maxillary second molar did not reveal the aberrant anatomy due to its location and impaction of maxillary third molar onto the roots of the second molar. After access opening, inspection of the pulp chamber floor revealed a slightly deviated location of the palatal canal and a bleeding point mesial to the palatal canal. Intensive exploration for determining any additional canals was done using David Green (DG) 16 endodontic explorer under 3X magnification using dental loupes. A narrow field of view Cone Beam Computed Tomography (CBCT) was obtained to evaluate the unusual root canal morphology. Following a thorough analysis of CBCT, root canal treatment was performed employing a standard protocol. This case report highlights the successful diagnosis and management of the bilateral maxillary second molar with two separate palatal roots. With CBCT and magnification, determining the root morphology and canal configuration will be more accurate, further improving the quality of root canal treatment.

Micro-CT evaluation of maxillary first molars: interorifice distances and internal anatomy of the mesiobuccal root.

This study aimed to describe the morphometric relationship of root canal orifices on the pulp floor in the presence/absence of mesiobuccal second canal (MB2) in the maxillary first molars and other aspects of its internal anatomy. Sixty-two maxillary first molars were scanned by micro-CT. The presence of the MB2 canal was verified. The distance between the center points of the MB1, MB2, distobuccal (DB), and palatal (P) canal orifices on the pulp floor were measured (MB1-MB2, MB1-DB, MB2-DB, MB1-P, and DB-P). The MB1-P to DB-P ratio was calculated. The distances between the anatomic apex and the MB1 and MB2 apical foramina were measured. The length of the band-shaped isthmus was also measured. Student's t-test was applied to verify the association between the presence of an MB2 canal, the interorifice distances, and the ratio of the MB1-P to DB-P distance (α = 5%). The MB2 canal was present in 43 roots (69.35%). Statistics showed significant differences when MB2 was present for the largest MB1-P distance (p < 0.05) and higher values for the MB1-P to DB-P ratio (p < 0.05). A band-shaped isthmus was detected in 25.8% of MB roots. The mean distance from the apical foramen to the isthmus floor ranged from 1.74 for MB1 canals to 1.42 for MB2 canals. Canal orifice distances on the pulp floor may predict the presence of MB2 canals. There was a high incidence of isthmus, accessory canals, and apical delta in the critical apical zone in MB roots of maxillary first molars.

Working Length of Maxillary Primary First Molars in Children Aged 2-6 Years

An accurate and reproducible working length determination is a crucial aspect in pulpectomy. The cleaning, shaping and obturation cannot be adept precisely unless the working length is determined accurately. The determination of precise working length is one of the keys to accomplishment in endodontic therapy. Thus the aim of the study was to compare the working length of each root canal obtained for primary maxillary first molars in children aged 2-6 years. A retrospective study was carried out using digital records of 1,372 children who reported to the Department of Paediatric and Preventive Dentistry from June 2019 to March 2020. A total of 380 records were finally included for the study evaluation, which included maxillary primary first molars (54,64) Patients between the age group of 2-6 years were included in the study. The following data were retrieved from the dental records: age, gender, working length of each canal and pulpal pathology. The records were examined and noted in a spreadsheet. The collected data were analysed by computer software SPSS version 21 using one-way Anova test with the level of significance set at 5%. The mean age was observed to be 4.14 years in the present study. The mean working length was found to be 9.82mm (MB canal), 9.79mm (DB canal), 13.28mm (Palatal canal) with respect to pulpal pathology such as pain, swelling, abscess and resorption (P = 0.00). The reported data may help clinicians to obtain a thorough understanding of the working length of the primary maxillary first molars.

Endodontic management of maxillary first molar with two palatal canals

Having a thorough knowledge about the internal anatomy of a tooth and its possible variations is an important aspect for the success of a root canal therapy. Variations in the number of roots, root canals and configurations affect the treatment outcome. Moreover, missed canals make up for the highest chances of failure of endodontic therapy(1).&#x0D; &#x0D; A maxillary first molar shows lot of variations in the anatomy. Although finding MB2 canal has now become a routine procedure, but variations in the palatal canal is still aberrant which concerns the clinicians. With the advancements in radiographic procedures, it has now become an easy task to look for aberrations in tooth anatomy. One such advancement is the Cone Beam Computed Tomography (CBCT) which acts as the third eye for clinicians. It helps in accurate diagnosis and in negotiating the complex morphologic variations in root canals(2).&#x0D; &#x0D; This case report presents the endodontic management of a maxillary first molar presenting with five canals with two palatal canals confirmed with the aid of Cone Beam Computed Tomography.

The role of palatovaginal canal and sphenopalatine artery in the localization of vidian canal during vidian neurotomy

Objective:To explore the role of palatovaginal canal and sphenopalatine artery in the localization of pterygoid canal during pterygoid neurotomy. Method:55 patients with or without nasal polyps were divided into two groups: group A（twenty-nine cases, anterior wall approach of sphenoid sinus） and group B（twenty-six cases, middle nasal meatus approach）. All patients underwent unilateral vidian neurectomy under nasal endoscope. The vidian canal was located by palatal canal and sphenopalatine artery in group A and B, respectively. Result:The vidian canal was located successfully in all patients, with small wound, fast postoperative recovering. There was no irreversible complication. Conclusion:The relationship between the palatovaginal canal, sphenopalatine artery and the external orifice of vidian canal is constant, which can be used as an anatomical marker of vidian neurotomy.

Retreatment of Root Canals Filled with BioRoot RCS: An In Vitro Experimental Study

IntroductionThe purpose of this study was to compare the speed of removal of root canal filling material and re-establishment of apical patency in root canals filled with a tricalcium silicate–based sealer (BioRoot RCS [BRCS]; Septodont, Saint-Maur-des-Fossés, France) versus a zinc oxide–eugenol sealer (Pulp Canal Sealer [PCS]; Sybron Endo Kerr, Orange, CA) and to analyze the effect of the operator’s experience. MethodsOne hundred twenty root canals of 40 Dentalike dental simulators (Dentsply Sirona, York, PA) were shaped with a WaveOne (Dentsply Sirona) reciprocating file using short 3-mm strokes. Root canals were obturated using a single gutta-percha cone and either BRCS or PCS. Samples treated either with BRCS or PCS were equally dispatched between experienced practitioners and junior practitioners. The time required to remove root filling material and establish apical patency was recorded for each root canal. Samples were compared according to the sealer used and the practitioner’s experience (Mann-Whitney test). ResultsOne hundred fifteen root canals were successfully retreated. No differences in the time required to remove the filling material were observed between the 2 materials for mesiobuccal or distobuccal canals (P > .05). In contrast, the procedure was longer for palatal canals filled with BRCS compared with PCS (79.10 vs 182.45 seconds, P < .01). Experienced practitioners took significantly less time than junior practitioners (P < .05). ConclusionsBRCS can be successfully removed from root canals as quickly as a zinc oxide–eugenol sealer in both mesiobuccal and distobuccal canals but not in palatal ones. The duration of the procedure was affected by the operator’s experience independent of the filling material used or the canal type.

Maxillary first molar with extra palatal canals

Knowledge of the root canal anatomy and its variations is essential for successful completion of the endodontic treatment. Root canal treatment of maxillary first molars with aberrant canal configuration can be challenging. The incidence of two palatal canals in a palatal root is quite rare and had never been reported among Lebanese population. This manuscript reviews the incidence of maxillary molars with two palatal root canals reported in the literature as well as reporting the endodontic management of a maxillary first molar having two canals in the palatal root one mesial and another distal, in addition to one mesiobuccal and one distobuccal canals for a Lebanese patient.

Position of Orifice of Distobuccal Canal of Maxillary Second Molars Using Cone-Beam Computed Tomography.

Background and ObjectivesThis study aimed to assess the position of distobuccal canal orifice of maxillary second molars using cone-beam computed tomography (CBCT).Materials and MethodsA total of 301 CBCT scans of patients were retrieved from the archives of a radiology clinic, and the distance between the orifices of distobuccal and mesiobuccal root canals, the distance between the orifices of distobuccal and palatal root canals and the angle between the orifices of mesiobuccal, distobuccal and palatal root canals in the axial plane were measured on CBCT scans.ResultsOf 301 maxillary second molars evaluated in this study, 202 (67.1%) had three canals and 99 (32.9%) had four canals. The distance between the distobuccal and mesiobuccal canal orifices (DM) ranged from 1.10 to 4.40 mm (mean: 2.1831±0.6370 mm). The distance between the distobuccal and palatal canal orifices (DP) ranged from 1.20 to 6.20 mm (mean: 3.8704±0.84944 mm). The mean angle between the mesiobuccal, distobuccal and palatal orifices (MDP) was 106.37±12.12075°.ConclusionAround one-third of maxillary second molars had four canals; the rest had three canals. No maxillary second molar with two canals was found. The orifice of distobuccal canal was located at 2 mm distance from the mesiobuccal canal orifice in distopalatal direction in the majority of cases. It had 3 to 4 mm distance from the palatal canal orifice in most cases. CBCT is recommended to find the orifice of distobuccal canal in cases in whom negotiation of this canal is challenging.

Impacts of 3 Different Endodontic Access Cavity Designs on Dentin Removal and Point of Entry in 3-dimensional Digital Models

IntroductionThe purpose of this study was to evaluate the tooth structure theoretically required to be removed in the coronal and cervical regions to accomplish 3 different endodontic access preparations in a novel digital model. The deviation of the center of access cavity from the central fossa will also be measured and compared among the 3 endodontic cavity designs, which in turn may serve as suggested points of entry for different access openings. MethodsTwenty-one maxillary molars and 15 mandibular molars were selected and 3-dimensionally imaged with cone-beam computed tomographic imaging. Three-dimensional (3D) volume reconstructions were made and converted into stereolithography files. Digital access cavity preparation was performed on each 3D reconstruction model with the 3 most commonly used endodontic access preparations: minimally invasive (MI), modified straight-line (MS), and traditional straight-line (TS) techniques. After the access cavity outlines were determined, digital sectioning of each reconstructed 3D tooth model was performed orthogonal to the long axis of the tooth at 3 levels: (1) passing through the central fossa, (2) 1.5 mm apical to the central fossa, and (3) 2 mm apical to the cementoenamel junction. The linear distance from the centroid of the access opening to the central fossa was measured to calculate the point of entry, and the amount of tooth structure removal at the pericervical area was measured to calculate the theoretically minimum amount of linear dentin removal required. Two-way repeated measures analysis of variance was performed for the interactions between different access designs and the amount of cervical dentin removal. Other data were statistically analyzed with 1-way repeated measures analysis of variance. The Tukey post hoc test was used for multiple comparisons. Significance was set at .05. ResultsThe amount of deviation of the center of the access cavity from the central fossa in all test groups was less than 1 mm. The dimensions of access openings differed significantly among the 3 access forms (TS > MS > MI, P < .0001). The amount of required cervical dentin removal was the greatest in the TS method followed by the MS and MI methods (P < .0001). ConclusionsThe central fossa could serve as good starting points in all access preparations in both maxillary and mandibular molars. Dentin removal in the coronal and cervical regions was the greatest in the TS design followed by the MS and MI designs. When comparing different canals in the same access form, less cervical dentin was sacrificed in the palatal canals of maxillary molars and the distal canals of mandibular molars.

Root canal morphology of primary maxillary second molars: a micro-computed tomography analysis.

Successful endodontic treatment of primary teeth requires comprehensive knowledge and understanding of root canal morphology. The purpose of this study was to investigate the root canal configurations of primary maxillary second molars using micro-computed tomography. Extracted human primary maxillary second molars (n = 57) were scanned using micro-computed tomography and reconstructed to produce three-dimensional models. Each root canal system was analysed qualitatively according to Vertucci's classification. 22.8% (n = 13) of the sample presented with the fusion of the disto-buccal and palatal roots; of these, Type V was the most prevalent classification. For teeth with three separate roots (n = 44), the most common root canal type was Type 1 for the palatal canal (100%) and disto-buccal canal (77.3%) and Type V for the mesio-buccal canal (36.4%). Overall, 7% (n = 4) of mesio-buccal canals were 'unclassifiable'. The root canal systems of primary maxillary second molars were not only complex but had a range of configurations that may contribute to unfavourable clinical outcomes after endodontic treatment.

Two Canals in Palatal Root of Maxillary Molar: Case Series

Evaluating morphology of a root canal is important in determination of a successful endodontic therapy. This article highlights the need to be aware of different morphologies, which can exist in the root canal system of upper molars. This is usually associated with buccal root and has been documented in several studies in literature. On the other hand, it is not often that we come across variations in the palatal roots. These cases discuss such a case where two canals were discovered in palatal root during root canal treatment of maxillary first molar. It is essential to evaluate pre-operative radiographs and have proper knowledge of anatomy of the root canal system before initiating the treatment. All roots must be explored carefully to ensure that all canals are negotiated, debrided and obturated to ensure successful endodontic outcome. This case report shows a case series in endodontic management of a maxillary first molar with two palatal canals.