Separate Root Canals Research Articles

Influence of different working lengths on the shaping ability of Reciproc Blue in the apical third and apical foramen

Aim: This study aimed to assess the shaping ability of Reciproc Blue in the apical third and apical foramen of moderately curved canals at different working lengths (WLs), by micro-computed tomography. Methods: Thirty-six mesial roots (mesiobuccal and mesiolingual canals) were included, each with 2 separate root canals and independent apical foramina, according to type IV of Vertucci’s classification of first and second mandibular molars. The canals were instrumented at three different WLs: G-1, 1mm short of the major apical foramen; G0, at the major apical foramen; G+1, 1mm beyond the major apical foramen. The groups were assessed for changes in root canal volume and untouched wall area in the apical third. Groups G0 and G+1 were also compared for percentage of untouched walls at the apical foramen. One-way ANOVA (post hoc Tukey test) and Student’s t-test adopted a 5% level of significance. Results: Root canal volumes (mm3) in the apical third were 22.86±10.46, 44.48±24.91, and 55.71±21.32 in G-1, G0 and G+1, respectively. G-1 volume following instrumentation increased significantly less than that of G0 or G+1 (P>.05); G0 did not differ from G+1. The percentage of untouched wall area in the apical third did not differ among the three groups (P>.05). G0 and G+1 did not differ regarding untouched walls in the major apical foramem walls. Conclusion: Extending the WL from 1mm short of the apical foramen to a point at and beyond the WL increases the apical third volume without increasing the prepared area. Untouched surface areas of the apical foramen were not modified by instrumentation at or beyond the foramen.

Concurrence of Maxillary Fused Primary Central Incisor With Permanent Supernumerary Tooth: A Case Report

A non-common case of unilateral fusion between the left upper central tooth and the supernumerary deciduous tooth, which also has an extra maxillary impacted tooth, was reported in the present study. The patient was a 9-year-old Iranian boy. The left lateral maxillary tooth was found during the oral examination. In the radiographic presentations, the fused teeth showed separate roots, pulpal chambers, and separate root canals. Delayed eruption of the first and second maxillary permanent incisors was experienced due to the presence of an extra impacted tooth. In the management of this condition, both the deciduous fused teeth and extra impacted teeth were removed, and an appointment was scheduled for three months to check for spontaneous tooth eruption.

Endodontic treatment of the maxillary first molar with palatal canal variations: A case report and review of literature

Root canal variations frequently occur in maxillary first molars, which greatly affects the success of its treatment. The second mesiobuccal (MB) root canal is the most common root canal variation. However, only a few studies have been conducted on palatal root canal variations. Herein, we report the presence of two separate root canals in a palatal root of the maxillary first molar. A 39-year-old woman complained of pain in the maxillary right region for 1 year, which recently worsened. Clinical examination revealed a poorly restored right maxillary first molar and caries detected at the filling marginal. Cold and heat test results indicated severe pain in the right maxillary first molar. The patient was diagnosed with irreversible pulpitis, and subsequently, root canal treatment (RCT) was performed. In total, five root canals were found in the maxillary first molar, including two separate root canals in the palatal root. RCT was successfully performed using an endodontic microscope and cone-beam computed tomography (CBCT). The CBCT image revealed a vertucci type I canal morphology in the distobuccal root, while the MB and palatal root canals were type Ⅳ. At the 1-mo follow-up, the maxillary first molar was completely asymptomatic, and the X-ray results indicated a successful RCT. Finally, the ceramic crown restoration was performed. An endodontic microscope and CBCT are useful in effectively identifying and treating root canal variations.

Comparative evaluation of dentin volume removal and centralization of the root canal after shaping with the ProTaper Universal, ProTaper Gold, and One-Curve instruments using micro-CT.

Background. The main goal of our study was to assess the volume of dentin removed and transportation in root canals using ProTaper Universal (PTU), ProTaper Gold (PTG) and One-Curve (OC). Ni-Ti rotary instruments in extracted human teeth using by micro-CT. Methods: Thirty human upper 1st premolar teeth with two separate root canals and sturdy, mature root tips were used in the present study. Specimens were decoronated and root length was standardized for micro CT scanning before root canal preparation done. The teeth were randomly separated into three categories (n = 10) according to the rotary NiTi system used for canal instrumentation, i.e., PTU (Dentsply, Maillefer), PTG (Dentsply, Maillefer), and OC (Micro-Mega SA). After root canal preparation, samples were scanned again on micro-CT by the same scanning parameters. Surface area, canal volume, structure model index (SMI), percentage of uninstrumented area and transportation parameters were obtained for each sample before and after micro-CT analyse. Results: No significant differences between the PTG and PTU in terms of the total volume of removed dentin, surface area and percentage of uninstrumented areas were found. However, regarding to parameters above, OC showed a lower efficacy than PTG and PTU in coronal section. Regarding canal transportation, PTG and OC showed lower mean transportation values at all levels. Conclusion: This paper demonstrated the root canal shaping abilities of the PTU, PTG, and OC NiTi file systems. The PTG and OC systems were associated less canal transportation and a better ability to preserve dentinal walls than PTU. There was no significance different between all rotary file systems for SMI values however, PTU and PTG showed greater canal volume and surface area change than OC file systems in coronal section.

Endodontic management of a mandibular second molar with five distinct root canals

Adequate knowledge on the root canal morphology is essential for successful root canal treatment. Mandibular molar teeth show considerable variations in their external and internal radicular morphology that require special attention from dental practitioners to provide the best clinical outcomes for the patients. The occurrence of three separate root canals in the distal root of a mandibular molar is uncommon. This article aims to present the endodontic management of a mandibular second molar that has five separate root canals (two root canals in the mesial roots and three root canals in the distal roots). Keywords: Distal, endodontic treatment, mandibular molar, root canal, root canal morphology, root canal treatment

A Successful Root Canal Therapy of a Maxillary First Molar With 3 Separate Root Canals in the Mesiobuccal Root: Case Report

Introduction: An important issue in treatment planning and endodontic treatment is to deal with sophisticated internal dental morphology. Deviations from normal anatomy in maxillary molars are usually related to the number of canals in mesiobuccal root. Although unusual anatomy is not uncommon in maxillary molars, the occurrence of 3 separate canals with distinct orifices and apical foramina (as we see in this case) is extremely rare. Getting familiar with this unusual anatomy helps clinicians to treat patients more efficiently with less chance of failure. Case Presentation: This case report describes a successful endodontic management of an uncommon variation of the maxillary first molar with a third mesiobuccal canal. The tooth had a deep carious lesion and the pulp was irreversibly damaged causing pain on the left side of the face. The periodontium was normal. The tooth received root canal treatment and 400 mg ibuprofen was prescribed every 6 hours for 2 to 3 days. The patient remained asymptomatic and the 3-month follow-up radiograph revealed normal periodontium. Conclusions: Inability to identify and treat additional canals that are very common in the MB root of maxillary first molar could lead to treatment failure.

Apical Root Canal Morphology of Mesial Roots of Mandibular First Molar Teeth with Vertucci Type II Configuration by Means of Micro–Computed Tomography

IntroductionThe aim of this study was to assess the features of the apical root canal anatomy and its relation to the level at which 2 separate root canals merge in the mesial roots of the mandibular first molars with Vertucci type II canal configuration by using micro–computed tomography analysis. MethodsThe anatomic features of the apical 3 mm of root canals in 83 mesial roots of mandibular first molar teeth were investigated by micro–computed tomography and software imaging according to the level at which 2 separate root canals merge. The most apical slice where a visible root canal was detectable was recorded as 0 level. The specimens from where 2 root canals rejoin at within 3 mm from the 0 level were then assigned to group 1 (n = 37), whereas the specimens from where root canals rejoin 3–9 mm from the 0 level were assigned to group 2 (n = 46). Data were presented by using descriptive statistics and Mann-Whitney U tests, with the significance level set at 5%. ResultsIn all specimens the long oval type of cross-sectional shape increased from 50.9% at 1 mm to 80.5% at 3 mm. Group 1 presented significantly higher major diameter values compared with group 2 (P < .05). There was no significant difference regarding minor diameter values (P > .05) between groups. Group 2 displayed significantly higher roundness values than group 1 (P < .05). ConclusionsA long oval root cross section of apical root canal anatomy is more prevalent in roots for which 2 root canals merge within apical 3 mm of root canals.

Management of a mandibular first molar with three separate root canals in the distal root

Adequate knowledge on the root canal morphology is essential for successful root canal treatment. Mandibular molar teeth show considerable variations in their external and internal radicular morphology that require special attention from dental practitioners to provide the best clinical outcomes for the patients. The occurrence of three separate root canals in the distal root of a mandibular molar is uncommon. This article aims to present the endodontic management of a mandibular first molar that has five separate root canals (two root canals in the mesial roots and three root canals in the distal roots).

C-SHAPED CONFIGURATION OF THE ROOT CANAL SYSTEM – PROBLEMS AND SOLUTIONS

Introduction: The patients with C-shaped configuration of the root canal system are definitely a problem in the everyday dental practice. The C-shaped configuration of the root canal can be seen in the mandibular and maxillary molars. The treatment of these teeth is very difficult. Purpose: To trace the treatment of clinical cases with C-shaped configuration of the root canal system. Material and methods: There are some different cases that are described with a C-shaped configuration of the root canal system with one, two, three and four separate root canals. Careful exploration of the floor of the pulp chamber, inspection with magnification, use of ultrasonic irrigation and a modified filling technique are of particular use. Results and Discussion: Clinical cases of a Cshaped pulp chamber and root canal system shows that this root canal aberration occurs in a wide variety and variability with a single root canal up to two, three and four separate root canals. The diameter of the root canal themselves also varies from very wide to such with a small diameter. Conclusions: Knowledge of the different anatomical variations will improve the endododntic practice of the general dental practitioners.

Effects of three nickel titanium instrument systems on root canal geometry assessed by micro‐computed tomography

To compare and evaluate the shaping ability of several nickel titanium instrument systems with different motions: two reciprocating single-file systems (Reciproc and WaveOne) and one continuous rotation/reciprocation full-sequence system [Twisted File (TF) Adaptive] using micro-computed tomography. A total of forty-eight mesial canals of mandibular molars with two separate root canals and severe angles of curvature were selected. Canals were divided randomly to one of three experimental groups: group 1, reciprocating instrumentation with Reciproc R25, group 2, reciprocating with the Primary WaveOne file and group 3 'Adaptive Rotary Motion' with Twisted Files. Each group consisted of 16 root canals. Canals were scanned before and after root canal preparation, with a resolution of 20 μm using a micro-computed tomography system. The following parameters were assessed: changes in dentine volume, percentage of unshaped canal walls, degree of canal transportation and centring ability. Data were analysed using analysis of variance and Tukey's post hoc tests test to explore a significant difference in mean dentine removal, mean percentage of noninstrumented canals, mean degree of canal transportation and centring ratio between groups in the apical third and along the entire root canal. The level of significance was set at α = 0.05. Preoperatively, there were no differences regarding root canal curvature and volume between experimental groups (P > 0.05). Overall instrumentation led to enlarged canal shapes with no evidence of preparation errors. None of the three groups was able to shape completely the root canal system. Mean dentine removal along the entire canal and in the apical third was significantly higher with Reciproc when compared with TF Adaptive and WaveOne (P = 0.013). Mean degree of canal transportation was significantly lower with TF Adaptive (P < 0.0001) followed by WaveOne and highest with Reciproc in the apical third and along the entire root canal. None of the NiTi systems was able to instrument completely the entire root canal. Reciprocation and Adaptive Motions were found to cut dentine efficiently to full working length, with no procedural errors. The TF Adaptive system maintained the original canal anatomy with less canal transportation and better centring ability.

Complete bilateral gemination of maxillary incisors with separate root canals.

Developmental anomalies in the hard tissue are seen frequently in dental practice. Gemination and fusion are the most commonly encountered anomalies, and distinction between the two is always challenging. Gemination, also called double tooth, is an anomaly exhibiting two joined crowns and usually a single root. It represents an incomplete attempt of a single tooth germ to split. It is considered multifactorial in etiology, with genetic and environmental causes. This paper discusses a rare example of bilateral gemination (prevalence 0.04%) of maxillary central incisors with completely separated roots. Multidisciplinary care ensured a successful esthetic and functional outcome.

Endodontic management of a supernumerary tooth fused to the maxillary permanent lateral Incisor

The aim of this case report is to present the endodontic management of a supernumerary tooth fused to the maxillary left lateral incisor. Such anomalies pose a challenge even to the most experienced clinician in treating these teeth. This report described a case of 21-year-old male patient with a classic case of complete fusion of maxillary left lateral incisor and a supernumerary tooth. A modified access preparation was made and two separate root canal orifices were identified. Both root canal systems were prepared separately and obturated efficiently until accepted lengths. This reported case highlights the importance of clinical and radiographic correlation in arriving to a definitive diagnosis.

Unusual Root Canal Morphology of the Maxillary Second Molar: A Case Report

Introduction. This clinical case report presents the successful endodontic treatment of a maxillary second molar that has a mandibular molar-like anatomy with no palatal root and with each of its roots containing two separate root canals. Cone-beam computed tomography (CBCT) was used to confirm this unusual anatomy. Methods. A 34-year-old male patient was referred to the Department of Endodontics at Inonu University's Faculty of Dentistry because of severe pain in his right maxillary second molar. Clinical and radiographic examinations identified unusual roots and root canals anatomy, and CBCT was planned in order to understand the nature of these variations. Cleaning and shaping procedures were performed using the crown down technique with Sybron Endo (Glendora, CA, USA) rotary instruments, and endodontic treatment was completed with gutta-percha cones and AH Plus resin sealers using the cold lateral compaction technique. Conclusions. The maxillary second molar exhibits aberrations and variations in terms of the numbers and configurations of its roots and root canals, and CBCT can be a useful imaging technique in endodontics.

A case of unusal anatomy : A mandibular second premolar with four separate canals

The aim of this case report is to describe the diagnosis and treatment of a rare case of mandibular second premolar with two roots and four separate root canals. The pre-operative radiograph showed two separate roots one mesially and other distally. During access cavity preparation four canal orifices were located using operating microscope and pre-operative Denta-scan readings. A proper cleaning and shaping was done immediately. After 3 weeks all the four canals were obturated with gutta percha and AH plus sealer using lateral condensation technique.The anatomic make-up of the root canal system with aberrant morphologies like these can only become clear from reports like these on endodontic treatment.

Endodontic Management of Two-rooted Mandibular Premolars using Spiral Computed Tomography: A Report of Two Cases

To present a unique case of mandibular first and second premolars with two roots and two root canals with the aid of spiral computed tomography (SCT). Confirmation of morphology of mandibular first and second premolars with the aid of SCT. Mandibular premolars usually have a single root and a single canal. The occurrence of two roots with two separate root canals is extremely rare. The use of SCT in this rare case greatly contributed toward making a confirmatory diagnosis and successful endodontic management. Successful nonsurgical endodontic management of mandibular first and second premolars with two separate roots and root canals has been presented. In this case, exact root canal anatomy could not be confirmed by using radiographs alone. Hence, the use of SCT helped us in making a confirmatory diagnosis. Developmental anomalies can occur in any tooth and two rooted premolars are no exception. The complexity of such teeth has to be considered for planning endodontic treatment using latest diagnostic equipment to increase the chances of success.

Maxillary permanent second premolar with three roots and root canals

Although maxillary first premolar with three root canals has been reported on a few occasions in the literature, three-rooted maxillary second premolars have rarely been observed. Here, we describe a maxillary second premolar with three roots and canals; two buccal and one palatal. Two buccal roots were completely separated in the furcal region and fused at the apical one-third of the root probably by the cementum while the single palatal root was completely separated. When the internal root anatomy was examined, the tooth had three separate root canals leaving from the pulp chamber all the way through to the apex. We discuss the possibility of different root and canal variations of the maxillary second premolar from a developmental point of view.

Initial apical fit of K‐files versus LightSpeed LSX instruments assessed by micro‐computed tomography

To compare the apical fit in two dimensions of the first K-file versus the first Lightspeed LSX instrument binding at working length after an initial crown-down preparation. Twenty maxillary molars with fully developed roots and four separate root canals were selected. Canals were pre-flared with ProFile.04 taper instruments to three quarters of estimated working length. Working length was electronically determined using a size 06 K-file. Progressively larger K-files were inserted passively to working length. The first binding K-file was termed initial apical file (IAF). Then, the first binding LSX initial apical lightspeed-instrument (IAL) was determined. Teeth were scanned with and without instruments in place using micro-computed tomography. Cross-sections of the apical part of the root canals were analysed as follows: the largest and smallest diameters of the root canal and the diameter of the instrument were calculated and related to each other. Statistics were performed using Kruskal-Wallis test and Wilcoxon test. The alpha-type error was set at 0.05. Initial apical file sizes ranged from 8 to 30 and were lowest in second mesiobuccal and highest in palatal canals. IAL sizes ranged from size 20 to 40. The apical large canal diameter was assessed more accurately by the LSX instruments (P < 0.0001). However, the smallest available LSX instrument (i.e. size 20) did not reach working length in 39 of 80 canals. Instruments with a flat widened tip were found to determine apical cross-sectional diameter better than round, tapered instruments.

Interdisciplinary Treatment of a Fused Lower Premolar with Supernumerary Tooth

The objective of this report is to describe combined orthodontic and endodontic treatment of a fused mandibular premolar with supernumerary tooth. The patient was a 15 year old girl seeking orthodontic treatment for the correction of maxillary and mandibular crowding. Cephalometric examination revealed skeletally Class I relationship. The panoramic radiograph showed a fused tooth with two separate pulp chambers and two separate root canals connecting in apical third. After the endodontic treatment of the fused teeth, the stripping of the supernumerary tooth was performed to establish a Class I canine relationship and to correct midline deviation. At the end of the treatment, the crowding was resolved and positive overjet and overbite was achieved.

Three-dimensional Analysis of Mesiobuccal Root Canal of Japanese Maxillary First Molar Using Micro-CT

The objective of this study was to three-dimensionally observe the morphological characteristics of mesiobuccal root canals of Japanese maxillary first molars using microcomputed tomography (Micro-CT) and classify root canal variations. This study used 90 maxillary first molars. Three-dimensional reconstruction was performed using data obtained by Micro-CT, and cross-sections of the root canals were observed. Moreover, the root canal morphology was classified by the configuration and root canal diameter, and was evaluated for occurrence using the classification by Weine et al. (1969) as a reference. Overall, single root canals were observed in 44.4%, incomplete separation root canals in 22.3%, and completely separate root canals (upper and lower separation root canals) in 33.3%. Mesiobuccal root canals often had intricate configurations, and accessory root canals (lateral canals and apical ramifications) were observed in most of the mesiobuccal root canals (76.7%), irrespective of whether there were ramifications of the main root canals. While there were no marked differences in the incidence of root canal ramifications between this study and earlier reports, the incidence of accessory root canals was higher in this study. This result may be explained by the far more superior visualization ability of Micro-CT than conventional methods, which allowed the detection of microscopic apical ramifications previously difficult to observe.

Apical fit of initial K‐files in maxillary molars assessed by micro‐computed tomography

To two- and three-dimensionally assess the fit of the first K-file binding at working length after a crown-down canal procedure. Twelve maxillary molars with fully developed roots and four separate root canals were selected. Canals were pre-flared using ProFile 0.04 instruments to three quarters of estimated working length (WL). WL was electronically determined using an ISO 06 K-file. Progressively larger K-files were inserted passively to WL. The first binding file was termed initial apical file (IAF). On micro-computed tomography (microCT) scans, cross-sectional areas of IAFs and canals and the largest and smallest root canal diameters were measured 1 mm from instrument tips. Volumes of the apical 2 mm of the instruments and corresponding root canal sections were calculated, and file binding was assessed. IAF sizes ranged from ISO-size 0.08-0.30 and were lowest in second mesiobuccal and highest in palatal canals. Files bound in the apical 2 mm in 96% of the canals. The mean canal area filled by the instruments 1 mm from the tip was below 40% in all canal types, the filled volume below 50% (anova, P > 0.05). The mean ratio (+/-SD) between largest and smallest canal diameter was 3.0 +/- 2.6 for first mesiobuccal, 3.3 +/- 2.6 for second mesiobuccal, 4.1 +/- 3.5 for distobuccal and 1.6 +/- 0.4 for palatal canals, indicating oval to flattened cross-sections. Two- and three-dimensional analysis of microCT scans revealed that whilst IAFs bound in the apical area, their fit was poor, because their shape does not correspond to maxillary molar canal anatomy.