Another Molar Saved

On 09/19/2011, in Apicoectomy, Endodontic Surgery, Healing, by Vladimir Tismensky, DDS

 35 year old healthy woman presented for evaluation and treatment of tooth #19. She reported a swelling and pain on biting.  My evaluation confirmed slight swelling and percussion tenderness on tooth #19. No perio probings more than 4mm. Radiographically, periapical radiolucency on the mesial and distal root, and a thin dentin wall mesial to the post were noted. After discussing treatment options, the decision was made to proceed with root end surgery. This patient was then prescribed a coarse of Clindamycin 300mg tabs and Peridex rinse, she was also given an Rx Motrin 800 and Vicoden for post-operative pain to use in a staggerred fashion and was reappointed for surgery.

Pre-op

 

Pre-op, thin dentin wall mesial to the post

 I apologize for dark pre-op and intra-op photographs.

Pre-op photo

MTA root end fillings including isthmus

 Bone graft was placed into the surgical crypt prior to closure.

Immediate Post-op

1 year recall

 One year recall shows complete periapical healing, tooth #19 is asymptomatic and functional.

1 year recall

 
2 Comments
Leave A Response

Unusual Anatomy Of The Mandibular First Premolar

On 09/09/2011, in Non-surgical Root Canal, Root Canal Anatomy, by Vladimir Tismensky, DDS

The normal anatomy of the mandibular first premolar is well documented in dental literature and text books.  However, there are variations in the number of roots, canals and foramenas.  A literature review by Cleghorn and Christie in JOE 2007, combining all cited studies with over 6700 teeth revealed the following with regards to the number of canals in the first mandibular premolar:

Single canal – 76% of teeth

Two or more canals – 24% of teeth

Angulated radiographs and their careful interpretation can give us a clue as to the complexity of the root canal space.  Specifically, a sudden disappearance of a canal space in the middle third of the root radiographically is a strong sign of multiple canals.  In addition, the use of the microscope and symmetry laws are especially helpful when unexpected or unusual anatomy is present.  In some cases, a cone beam image may be taken to get a better understanding of a root canal anatomy of a particular tooth.

I saw a 35 year old white male yesterday with irreversible pulpitis on tooth #21. His general dentist referred him for a root canal and noted the unusual anatomy of the pulp space.

Angulated pre-op radiograph reveals presence of more than one canal.

Pre-op tooth #21

Upon endodontic access and microscopic examination, four distinct canals were located and treated. A glass ionomer barrier was placed over the root filling material to augment the seal.

Post-op tooth #21

 

 
2 Comments
Leave A Response

Go To Top »