Clinical Continued »
exhibit a great variation in both root canal and root morphology compared to the conventional one root one canal found in Dental Anatomy textbooksı4 Vertucci (ı984)ı5
. found that in
400 mandibular first premolars investigated 74 per cent had one canal at the apex, 25.5 per cent had two canals and 0.5 per cent three canals. The incidence of two separate canals (Type IV configuration, see Fig ı on p37 ) was ı.5 per cent. One of the main reasons for endodontic failure is inadequate instrumentation and cleaning of the root canal systemı6
and, due
to the anatomical variations, the lower mandibular premolar has been described as presenting one of greatest the challenges to successfully treatı7
. A 5x5.5cm CBCT scan (Sirona
XG 3D) was taken to confirm the presence and location of the second canal. The root canals tend to be behind superimposed on a radiograph as they are behind each other in the bucco- lingual planeı8
. The CBCT images
showed there was a second root and canal located lingually (Fig 2). Under rubber dam and using microscope magnification the lingual canal was identified (Fig 3a). The canal was prepared with K files and rotary Wave One Gold Primary file (Fig 3b). The irrigation protocol was
copious sodium hypochlorite activated sonically with Endoactivator (Dentsply) and a penultimate rinse with ı7 per cent EDTA solutionı9
. The Master Apical
File size was 40. Two weeks later, after dressing with calcium hydroxide and glass ionomer, the symptoms had resolved. Under rubber dam the canal was accessed, working length and patency checked and irrigated with the above protocol. The canal was dried with sterile
paper points (Dentsply) and obturated with gutta percha and AH Plus sealer (Dentsply) using the warm vertical compaction technique (B&L Biotech) (Fig 3c). The access cavity was restored with SDR (Dentsply) and Venus Diamond (Heraeus Kulzer).
Continued » Ireland’s Dental magazine 35
Case three Internal resorption – 57-year-old female referred for RCT 36. Amenable for treatment, however, after accessing canals, two large vertical root fractures (mesio-distal and bucco-lingual) were observed and the tooth required extraction.
Case one Dens invaginatus – ı2-year-old boy, peg lateral and draining buccal sinus. (a) IOPA (b-d) CBCT axial views (e) CBCT sagittal views
Case two External cervical resorption – 24-year-old male referred for RCT ı6. (a) IOPA (b) CBCT axial view (c) CBCT coronal view. Tooth is unrestorable.
Case four 54-year-old female referred for RCT 26. Treatment was uneventful but, two weeks post-treatment the patient had symptoms. CBCT to assess apical pathology and quality of obturation. Nothing abnormal noted and patient is being treated for parafunction.
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