Palatal Canals Research Articles

Maxillary First Molar with two Palatal Canals: A Rare Case Report

Thorough knowledge of clinician about the internal anatomy and its possible variations is very important for the success of root canal therapy. Variations in the no. of roots, root canals and configurations make the therapy more difficult to perform.. Missed and non-negotiable canals during the treatment could affect the outcome of treatment. Clinician should be careful while treating maxillary first molars because of its root curvatures, additional canals and variations in internal morphology. Finding the MB2 canals in the mesiobuccal root is routine. Palatal canal is usually single, large canal which is broad mesiodistally and mirrors the root in which it houses. Rarely there are modifications in palatal canal. This paper presents a rare case report of endodontic management of a maxillary first molar with 2 palatal canals

Utilizing the GentleWave® System for Debridement of Undetected Apical Anatomy

Debriding and disinfecting complex anatomies within the root canal system pose a major challenge during root canal therapy. Even with current chemomechanical techniques, debris and bacterial remnants are commonly left behind, which are generally believed to increase the risk of endodontic failure. This case details the use of a new technique to debride complex apical anatomy in a maxillary molar. A 48-year-old female presented to the clinic with a chief complaint of increasing pain in her tooth. Clinical examination of the right first maxillary molar (#3) revealed moderate sensitivity to percussion and mild sensitivity to palpation. A pulpal diagnosis of symptomatic irreversible pulpitis and a periapi-cal diagnosis of symptomatic apical periodontitis were made. Mechanical instrumentation was performed using rotary file size #25/.04 for the mesiobuccal and distobuccal canals and size #25/.06 for the palatal canal to create a fluid path and enable obturation of the root canal system following the GentleWave® Procedure. The GentleWave Procedure was completed using Multisonic Ultracleaning™ for complete debridement and disinfection of the root canal system. The tooth was obturated using a warm vertical continuous wave obturation technique. Postoperative radiographs revealed complex anatomy within the apical third that was undetected both during pre-operative radiography and mechanical instrumentation. The palatal canal exhibited a complex apical delta with multiple points of exit, and the mesiobuccal canal revealed an undetected lateral canal within the apical third that had a separate and distinct egress. Conclusion and clinical significance: It is important for the clinician to debride and disinfect complex anatomy within the root canal system to reduce the risk of endodontic failure. This case report highlights the clinical significance of utilizing the GentleWave Procedure for detecting complex apical anatomy during endodontic therapy.

Determination of the Root Canal Length of Teeth of Bantu Patients Attending the Teaching Hospital of Kinshasa University

Background: There is paucity of literature on the determination of the root canal length of Bantu subjects in dental professional practicing in Africa and Democratic Republic of Congo in particular. Aims: The aim of the present study was to determine the root canal length of teeth of Bantu patients extracts attending the Teaching Hospital of Kinshasa University. Methods and Material: Prospective cross-sectional study was carried out in the service of Conservative Dentistry. The patients suffering with pulpitis of permanent teeth which were selected for root canal treatment during the period of January 2014 to December 2016 were included. All patients whose main root canals were inaccessible, teeth carrying prosthesis, teeth with large coronal decay, teeth having periapical periodontitis, supernumerary teeth, wisdom and primary teeth were excluded. Results: The upper canines presented some significant longer canals compared to the lower canine (23.4 ± 2.3 mm and 21.6 ± 1.8 mm). Palatal canals of the first and second molar were respectively longer as compared to the superior teeth canals (21.5 ± 1 mm, 21.3 ± 2 mm). The distal canals of the first and second molar were the longest in the mandibular arch respectively measuring 20.7 ± 2.0 mm and 21.5 ± 1.7 mm. Conclusion: Data obtained from Bantu patients show slightly shorter roots compared to some European populations, but longer than some Asian populations.

Influence of Access Cavity Design on Root Canal Detection, Instrumentation Efficacy, and Fracture Resistance Assessed in Maxillary Molars

IntroductionThe aim of this study was to assess the influence of contracted endodontic cavities (CECs) on root canal detection, instrumentation efficacy, and fracture resistance assessed in maxillary molars. Traditional endodontic cavities (TECs) were used as a reference for comparison. MethodsThirty extracted intact maxillary first molars were scanned with micro–computed tomographic imaging at a resolution of 21 μm, assigned to the CEC or TEC group (n = 15/group), and accessed accordingly. Root canal detection was performed in 3 stages:(1) no magnification,(2) under an operating microscope (OM), and(3) under an OM and ultrasonic troughing. After root canal preparation with Reciproc instruments (VDW GmbH, Munich, Germany), the specimens were scanned again. The noninstrumented canal area, hard tissue debris accumulation, canal transportation, and centering ratio were analyzed. After root canal filling and cavity restoration, the sample was submitted to the fracture resistance test. Data were analyzed using the Fisher exact, Shapiro-Wilk, and t tests (α = 0.05). ResultsIt was possible to locate more root canals in the TEC group in stages 1 and 2 (P < .05), whereas no differences were observed after stage 3 (P > .05). The percentage of noninstrumented canal areas did not differ significantly between the CEC (25.8% ± 9.7%) and TEC (27.4% ± 8.5%) groups. No significant differences were observed in the percentage of accumulated hard tissue debris after preparation (CEC: 0.9% ± 0.6% and TEC: 1.3% ± 1.4%). Canal transportation was significantly higher for the CEC group in the palatal canal at 7 mm from the apical end (P < .05). Canal preparation was more centralized in the palatal canal of the TEC group at 5 and 7 mm from the apical end (P < .05) and in the distobuccal canal of the CEC group at 5 mm from the apical end (P < .05). There was no difference regarding fracture resistance among the CEC (996.30 ± 490.78 N) and TEC (937.55 ± 347.25 N) groups (P > .05). ConclusionsThe current results did not show benefits associated with CECs. This access modality in maxillary molars resulted in less root canal detection when no ultrasonic troughing associated to an OM was used and did not increase fracture resistance.

Variations of Palatal Canal Morphology in Maxillary Molars: A Case Series and Literature Review

A series of challenging cases with unusual canal anatomy in the palatal roots of maxillary first and second molars is presented. A review of the literature was done to elucidate the prevalence of anatomic variations in the palatal canal of maxillary first and second molars. An uncertain or indefinite radiographic appearance of the palatal canal, or eccentric deviation of the master cone or previous root canal filling was considered an indication of a bifurcated palatal canal. Five maxillary molars with a bifurcated palatal canal were identified. A MEDLINE database search was performed to identify studies on the palatal canal morphology of maxillary first and second molars. Data were categorized based on the methodology used in each study. The overall prevalence of anatomic variations in the palatal canal of maxillary first and second molars was less than 2%; however, anatomic variations occurred more frequently in certain ethnic groups, reaching up to 33% in maxillary first molars and up to 14% in maxillary second molars. This case series showed that even experienced endodontic clinicians can miss a bifurcated palatal canal if they are not aware of or overlook the hidden clues for these anatomic variations. The traditional assumption of an exclusively single-canal anatomy in palatal canals of maxillary molars needs to be changed, even though it is the most prevalent anatomy. The overall low percentage of more than 1 palatal canal in maxillary molars is disturbingly misleading, because in certain ethnic groups this prevalence can be considerably higher.

Root Canal Treatment of a Maxillary First Molar with an Un-instrumented 5th Canal: A Clinical Case Report

Objective: Failure to identify and treat all canals within the root canal system is a major reason for endodontic failure. The morphological variations of the maxillary first molar have been the subject of many studies, with most studies focusing on multiple canals within the mesiobuccal root, but maxillary molars may also have fins, isthmi, lateral canals, and in this case, additional palatal canals. Identification and treatment of all canals and anatomical variations is vital for a successful endodontic outcome. Methods: A maxillary first molar with pulpal necrosis and asymptomatic apical periodontitis due to a deep carious lesion was accessed for root canal treatment under a dental operating microscope. Four canals were minimally instrumented to an apical size #20 and treated with the GentleWave® Procedure. The GentleWave Procedure involves Multisonic Ultracleaning™ that creates cavitation with activated distilled water, sodium hypochlorite and ethylenediaminetetraacetic acid (EDTA). After the GentleWave Procedure, a fifth canal, not previously realized, was detected in the palatal root. The fifth canal had been visibly cleaned of debris. Five canals were obturated utilizing gutta-percha and warm vertical condensation with an epoxy resin based sealer. Results: Post-operative radiographs show 5 root canals: 2 palatal canals, 2 mesiobuccal canals, and 1 distobuccal canal. A cone-beam computed tomography (CBCT) scan shows a three-dimensional fill and obturation of complex anatomy. Three-month follow-up evaluation shows radiographic and clinical healing, resolution of periapical lesions, and complete resolution of the clinical symptoms. Conclusion: This case reports describes successful endodontic treatment of a rare maxillary molar with 5 canals, one of which was uninstrumented, utilizing an advanced technology, the GentleWave Procedure. This report highlights the importance of identifying and cleaning complex anatomy to increase successful outcomes.

Prevalence and location of the secondary mesiobuccal canal in 1,100 maxillary molars using cone beam computed tomography.

BackgroundSeveral articles have used cone beam computed tomography (CBCT) to study the morphology of the maxillary molars and to ascertain its ability to visualize the second mesiobuccal canal (MB2); however, its geometric location has not been examined in depth. The aim of this study was to describe in vivo the prevalence and location of the MB2 in the mesiobuccal root of the first maxillary molar (1MM) and the second maxillary molar (2MM) through CBCT imaging.MethodsFive hundred fifty CBCT images of the 1MM and 550 of the 2MM were analyzed. To detect the MB2 canal, the observation and measurements were done 1 mm apically to the pulpal floor to standardize the methodology. The geometric location of the central point of the MB2 canal (PMB2) was measured in relation to the central point of the mesiobuccal canal (PMB1) and in relation to the line projected between the PMB1 and the central point of the palatal canals (PP). The data were analyzed using descriptive statistics, with a value of P < 0.05 being statistically significant.ResultsIn the 1MM, the prevalence of the MB2 canal was 69.82% and was more frequent in women (p = 0.005). The distance between PMB1 and PP was 7.64 ± 1.04 mm. The average distance between PMB1 and PMB2 was 2.68 ± 0.49 mm, and for PMB2 and the line projected between the PMB1 and PP canals was 1.25 ± 0.34 mm. In the 2MM, the MB2 canal was identified in 46.91% and was more frequent in men (p = 0.000). The distance between PMB1 and PP was 7.02 ± 1.30. The average distance between PMB1 and PMB2 was 2.41 ± 0.64 mm, and for the PMB2 and the line projected between the PMB1 and PP canals was 0.98 ± 0.33 mm.ConclusionsThe MB2 canal was found in a high percentage of the sample. These results indicate that CBCT is an effective, high-precision diagnostic tool not only for detecting but also locating in vivo the MB2 canal in the mesiobuccal root of upper molars.

Fracture Resistance of Premolars Restored Either with Short Fiber or Polyethylene Woven Fiber-Reinforced Composite.

To compare the fracture resistance of endodontically treated maxillary premolars with one remaining cavity wall restored either with short fiber-reinforced composite or polyethylene woven fiber-reinforced composite. Forty-eight maxillary premolars were endodontically treated and randomly assigned to four groups (n = 12). Palatal cusp was removed, buccal wall was remained. In groups 1 to 3, standardized cavities were prepared in the palatal canal entrances. In group 1, short fiber-reinforced composite was used for restoration both of deep cavity and coronal part. In group 2, short fiber-reinforced composite was placed inside the deep cavity and core part of the restoration. Coronal restoration was restored by using conventional filler composite. In group 3, both deep cavities and coronal parts were built up by using conventional filler composite. In group 4, post space was prepared in the palatal canal. Polyethylene woven fiber-reinforced composite post then was placed into post space and the coronal part was restored by using conventional filler composite. Specimens were placed into a universal testing machine. The fracture loads were recorded and analyzed statistically using one-way ANOVA (α = 0.05). Fracture patterns were analyzed by using Chi-square test (α = 0.05). No statistically significant difference was found in fracture strength (p > 0.05). Group 1 exhibited the highest and group 4 exhibited the lowest incidence of restorable fracture (p < 0.05). The restoration of severely weakened premolar teeth with the use of short fiber-reinforced composite might have advantages over conventional filler composite or polyethylene woven fiber-reinforced composite techniques. The results of this in vitro study will be helpful to understand reinforced composite materials for restoring endodontically treated maxillary premolars. (J Esthet Restor Dent 28:412-418, 2016).

Maxillary molar with two palatal canals type I: case report

This study aimed to describe a case report of endodontic treatment of a maxillary first molar with two roots and two palatal canals type I. The patient was referred to the Federal University of Pernambuco for endodontic treatment in left maxillary first permanent molar. After the clinical, physical and radiographic examination, the diagnosis was irreversible pulpitis. Radiographic examination showed a suggestive picture of a second palatal root. During access surgery, an alteration was observed in the pulp chamber and was then located the fourth canal, called distopalatal. The chemomechanical preparation was performed with rotary instruments of ProTaper Universal™ system and the irrigation was made with sodium hypochlorite 1%. At the end, there was an irrigation with 17% ethylene diamine tetra acetic acid, drying and filling with gutta-percha and Fill apex MTA cement, using the lateral condensation technique. This case demonstrates an unusual anatomical condition, enhancing that the knowledge of internal anatomy, as well as their diversity, is of key importance for successful endodontic treatment, and the dental surgeon should always be alert to possible morphological changes of tooth groups.

Maxillary Molar with Two Palatal Canals Type I: Case Report

Maxillary Molar with Two Palatal Canals Type I: Case Report

An in vitro study to determine fracture resistance of tooth roots after different instrumentation techniques

Aim: The aim was to study the influence of rotary and hand instruments techniques on the susceptibility of the root to fracture. Materials and Methods: Forty extracted human maxillary permanent first and second molars without any defects were selected as sample. Teeth were randomly divided into four groups of ten teeth in each group. Palatal canals were instrumented depending on the instrumentation techniques used in the groups. Group 1: 0.02 taper K-files and Gates Glidden drills (Mani Inc., Japan); group 2: Hand ProTaper (Dentsply-Maillefer, France); group 3: Rotary ProTaper (Dentsply-Maillefer, France); and group 4: Endowave (J. Morita, Japan). After instrumentation, palatal roots were resected and apical 7 mm sectionally obturated. Obturated roots were embedded in putty impression material and mounted on Universal testing machine (Lloyd instruments, UK). Vertical load was applied by means of a spreader inserted into the canal and load at fracture was recorded for each tooth. Fractured roots were embedded in self-cure resin, sectioned horizontally, and viewed under operating microscope to determine the direction of fracture line: Maximum and minimum remaining dentin thickness was measured at coronal, middle, and apical thirds. Statistical analysis of data was accomplished by one-way ANOVA and post-hoc tests with Tukey honest significant difference. Results: Mean fracture loads was 20.6 ± 3.8 kg (group 1), 9.5 ± 2.4 kg (group 2), 8.4 ± 1.4 kg (group 3), and 13.4 ± 3.1 kg (group 4). There was statistical significance in the values between group 1 and groups 2, 3, and 4 (P Conclusion: Preparation of canals with a conventional hand instrumentation technique using 0.02 taper K-files showed highest fracture resistance with least amount of dentin removed at all levels followed by Endowave, ProTaper Hand, and Rotary files.

Unusual location of second mesiobuccal orifice in maxillary second molar

Presence of second canal in mesiobuccal root of maxillary second molar is not uncommon but generally found closer to mesiobuccal orifice. This article reports a case of a maxillary second molar with an orifice of second mesiobuccal canal closer to palatal canal orifice.

Micro-CT Evaluation of Root Filling Removal after Three Stages of Retreatment Procedure.

The aim of this study was to quantify the residual filling material after filling removal, re-preparation with rotary or reciprocating files and passive ultrasonic irrigation (PUI). Twenty maxillary molars were prepared using ProTaper instruments up to F1. The teeth were filled with AH Plus and ProTaper gutta-percha points using the single-cone technique. Thereafter, the specimens were scanned using a micro-computed tomography system (Micro-CT #1). Then, the root canal filling was removed using ProTaper Retreatment files, and a new scan was performed (Micro-CT #2). The specimens were divided into two groups according to the instrument used for re-preparation: ProTaper rotary or WaveOne reciprocating files (Micro-CT #3). Finally, PUI was performed, and a new micro-CT scan was performed (Micro-CT #4). Intragroup and intergroup analyses were performed using Friedman and Dunn's post hoc test and the Kruskal-Wallis and Dunn post hoc tests, respectively. Palatal canal presented the highest volume of residual filling material in all stages of endodontic retreatment (p<0.05). The main reduction of filling volume was achieved after using ProTaper Retreament (p<0.05). The amount of remaining filling material after using ProTaper Retreatment was similar to that achieved with rotary and reciprocating files and after PUI (p>0.05). Rotary and reciprocating files achieved similar removal of the root canal filling (p>0.05). The greatest reduction in filling material was achieved after using ProTaper Retreatment files. Rotary and reciprocating instruments and PUI did not improve the removal of root canal filling materials.

Micro–Computed Tomography Analysis of the Root Canal Morphology of Palatal Roots of Maxillary First Molars

IntroductionA thorough knowledge of root canal anatomy is critical for successful root canal treatments. This study evaluated the internal anatomy of the palatal roots of maxillary first molars with micro–computed tomography (microCT). MethodsThe palatal roots of extracted maxillary first molars (n = 169) were scanned with microCT to determine several anatomic parameters, including main canal classification, lateral canal occurrence and location, degree of curvature, main foramen position, apical constriction presence, diameters 1 and 2 mm from the apex and 1 mm from the foramen, minor dentin thickness in those regions, canal volume, surface area, and convexity. ResultsAll canals were classified as Vertucci type I. The cross sections were oval in 61% of the canals. Lateral canals were found in 25% of the samples. The main foramen did not coincide with the root apex in 95% of the cases. Only 8% of the canals were classified as straight. Apical constriction was identified in 38% of the roots. The minor and major canal diameters and minor dentin thickness were decreased near the apex. The minor dentin thickness 1 mm from the foramen was 0.82 mm. The palatal canals exhibited a volume of 6.91 mm3 and surface area of 55.31 mm2 and were rod-shaped. ConclusionsThe root canals of the palatal roots were classified as type I. However, some factors need to be considered during the treatment of these roots, including the frequent ocurrence of moderate/severe curvatures, oval-shaped cross-sections, and lateral canals, noncoincidence of the apical foramen with the root apex, and absence of apical constriction in most cases.

Radiographic Study of the Problems and Failures of Endodontic Treatment

The aim of the present study was to determine radiographically the different reasons and problems of endodontic treatment failure. The periapical radiographs of 100 patients with one hundred teeth (130 root canals) were examined to identify the problems and failures of endodontic treatment. The various reasons of failure that is under filling, poor filling, over filling and presence of procedural errors were recorded for each root filled canal. Chi square test was used to determine statistical significance between different parameters. Under fillings were found in 46.9% of the root canals. The percentage of poor fillings and over fillings were 28.5% and 13% respectively. Separated instruments and strip perforations were present in 4% and 3% of the teeth, while the presence of furcal perforation and coronal leakage was observed in one case each (1%).Endodontic problems and failures were most commonly observed in molars compare to anterior and premolar teeth. Mesiobuccal, mesiolingual and distobuccal root canals were the most frequently canals with endodontic problems and failures. The relationship between mesiobuccal, mesiolingual and distal canals in mandibular molars and mesiobuccal, distobuccal and palatal canals in maxillary molars in terms of endodontic failures were statistically significant by chi square analysis (P≤0.05). The most common cause of endodontic treatment failure was under filling followed by poor filling and over filling and first molar was the most frequently involved tooth with endodontic problems and failures.

Endodontic Management of a Maxillary Lateral Incisor with 4 Root Canals and a Dens Invaginatus Tract

Dens invaginatus (DI) is associated with complex internal anatomy. This article represents a maxillary lateral incisor with 5 root canals including DI. The treatment was planned and performed using cone-beam computed tomographic (CBCT) imaging. After clinical and radiographic evaluations, tooth #7 was diagnosed with DI and pulp necrosis with symptomatic apical periodontitis. Periapical radiographs of the tooth showed 2 roots and complex internal anatomy. CBCT evaluation revealed tooth #7 had 5 separate canals (4 root canals and 1 DI canal extending through the root to the periodontal ligament), communication between DI and the root canal system, and severe and multiple curvatures of the palatal canals. Root canal treatment was completed in 2 visits. Modified access openings were required to safely treat the dilacerated palatal canals. At the 6-month re-evaluation, the patient reported he had remained asymptomatic and his tooth had remained functional since the treatment was completed. Clinical examination showed tooth #7 had no sensitivity to percussion or palpation, probe depths within normal limits (≤3 mm), and no mobility. Radiographic assessment of the tooth showed significant osseous healing of the preoperative lesion. Three-dimensional imaging is a valuable tool for endodontic management of teeth with complex internal anatomy. Three-dimensional imaging is recommended for evaluating and treatment planning cases with DI.

Accurate Measurement of Canal Length during Root Canal Treatment: An In Vivo Study

Objectives: To assess the consistency and accuracy of Electronic Apex Locator (EAL) (Root ZXII) in individual canals and its association with other clinical variables. Study Design: Cross-Sectional study. Place of study: Dental section of the Aga Khan University Hospital, Karachi, Pakistan. Materials and Methods: Working length was measured by EAL in 180 patients requiring endodontic therapy in molar and premolar teeth. The effects of clinical variables e.g. gender and pulpal status on the consistency and accuracy of EAL were recorded. Performance of apex locator was considered "Consistent" when the scale bar was stable and moved only in correspondence to the movement of file in the root canal. Accuracy was determined by inserting the file at the working length determined by the EAL and periapical view of radiograph was taken using paralleling technique. Estimated working length was considered accurate when the file tip was located 0-2mm short of the radiographic apex. If the file was overextended from the radiographic apex, it showed dysfunction of the EAL. Results: Consistency of EAL was found 97.6% in distobuccal canals, 91.1% in palatal canals, 73.7% in mesiolingual canals, 83.3% in mesiobuccal and 80.2% in distal canals. Accuracy of EAL was 91.4% in mesiolingual canal, 92% in mesiobuccal, and 90.2% in Palatal and 93.2% in distal canal. Conclusion: Consistency of electronic apex locator vary in different canals, however consistent measurements are highly accurate. No significant association was found between other clinical variables with the consistency and accuracy of EAL.

Endodontic management of a maxillaryfirst molar with three palatal canals - A case report

This case report presents a successful endodontic management of left maxillaryfirst molar with three palatal canals. This rare root canal morphology was diagnosed using dental operating microscope (DOM) and confirmed with cone beam computed tomography (CBCT). Axial CBCT images confirmed that the palatal canals merged with each other in the apical third and exited through one apical foramen. This report highlights the importance of magnification (DOM) and advanced imaging techniques (CBCT) in better understanding of complex Root canal anatomy.

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.

Endodontic treatment of maxillary first permanent molar with two palatal canals

Knowledge of the internal anatomy and anatomic variation of root canal system is vital for the success of the root canal treatment. Any missed canal contributes to the failure of root canal treatment in a short duration. Permanent maxillary first molar has been studied extensively due to high variation in internal anatomy and still pose a challenge to many clinicians. The following case report describes the management of maxillary first molar with two palatal canals.