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Cone beam computed tomography evaluation and endodontic management of permanent mandibular second molar with four roots: A rare case report and literature review.

Rajasekhara S, Sharath Chandra S, Parthasarathy LB - J Conserv Dent (2014)

Bottom Line: Knowledge of the most common anatomic characteristics and their possible variations is fundamental.This paper highlights endodontic management of mandibular second molar with four roots (two mesial and two distal) with one canal in each root and its cone beam computed tomography (CBCT) evaluation which was primarily done for post treatment assessment for diagnosing post-endodontic complications, at the same time confirmed our radiographic diagnosis of this variation.This also helped us portraying the anatomy of this rare variation.

View Article: PubMed Central - PubMed

Affiliation: Department of Conservative and Endodontics, Krishnadevaraya College of Dental Sciences, Bangalore, Karnataka, India.

ABSTRACT
The morphological variation in the number of roots and root canals, especially in multi-rooted teeth is a constant challenge for diagnosis and successful endodontic therapy. Knowledge of the most common anatomic characteristics and their possible variations is fundamental. Although, endodontic management of four-rooted mandibular first molars have been observed on a few occasions in the literature, to the best of our knowledge four-rooted mandibular second molars having two mesial and two distal roots have not been reported. This paper highlights endodontic management of mandibular second molar with four roots (two mesial and two distal) with one canal in each root and its cone beam computed tomography (CBCT) evaluation which was primarily done for post treatment assessment for diagnosing post-endodontic complications, at the same time confirmed our radiographic diagnosis of this variation. This also helped us portraying the anatomy of this rare variation.

No MeSH data available.


(a) Post-op radiograph, (b) 3D reconstruction of tooth #37
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Figure 2: (a) Post-op radiograph, (b) 3D reconstruction of tooth #37

Mentions: On preoperative radiographic evaluation of the involved tooth vague outline of the roots, radiopacities adjacent to the root of the multi-rooted tooth, presence of twin periodontal ligament outline of the roots revealed presence of supernumerary roots [Figure 1a]. Following local anesthesia administration, the tooth was isolated under rubber dam and access cavity preparation was done with endo access bur. Exploration of pulp chamber floor using DG 16 explorer revealed four distinct orifices: Mesiobuccal (MBR), mesiolingual (MLR), distobuccal (DBR), distolingual (DLR) [Figure 1b]. The naming for the canals in this case report is based on new anatomically based nomenclature system proposed by Denzil Valerian Albuquerque et al.,[2] this nomenclature has been used since it helps us to understand the variation of roots in relation with the root canals unlike other nomenclature system which considers only the variation in the root canal morphology without giving any consideration to the number of roots and its relation with root canals. Working length was determined [Figure 1c] three radiographs with different angulations was taken. Interpretation of these off angle radiographs revealed presence of four roots. Biomechanical preparation was performed with crown-down technique using NiTi rotary endodontic instruments (Protaper™, Dentsply). Apical canal size was prepared until size F2 for all the canals. Master cone selection was performed. All the root canals were obturated using zinc oxide eugenol sealer and Gutta-percha points (Protaper Gutta Percha™, Dentsply) and access was restored with dental amalgam. Post operative radiograph was taken. [Figure 2a and b].


Cone beam computed tomography evaluation and endodontic management of permanent mandibular second molar with four roots: A rare case report and literature review.

Rajasekhara S, Sharath Chandra S, Parthasarathy LB - J Conserv Dent (2014)

(a) Post-op radiograph, (b) 3D reconstruction of tooth #37
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4127702&req=5

Figure 2: (a) Post-op radiograph, (b) 3D reconstruction of tooth #37
Mentions: On preoperative radiographic evaluation of the involved tooth vague outline of the roots, radiopacities adjacent to the root of the multi-rooted tooth, presence of twin periodontal ligament outline of the roots revealed presence of supernumerary roots [Figure 1a]. Following local anesthesia administration, the tooth was isolated under rubber dam and access cavity preparation was done with endo access bur. Exploration of pulp chamber floor using DG 16 explorer revealed four distinct orifices: Mesiobuccal (MBR), mesiolingual (MLR), distobuccal (DBR), distolingual (DLR) [Figure 1b]. The naming for the canals in this case report is based on new anatomically based nomenclature system proposed by Denzil Valerian Albuquerque et al.,[2] this nomenclature has been used since it helps us to understand the variation of roots in relation with the root canals unlike other nomenclature system which considers only the variation in the root canal morphology without giving any consideration to the number of roots and its relation with root canals. Working length was determined [Figure 1c] three radiographs with different angulations was taken. Interpretation of these off angle radiographs revealed presence of four roots. Biomechanical preparation was performed with crown-down technique using NiTi rotary endodontic instruments (Protaper™, Dentsply). Apical canal size was prepared until size F2 for all the canals. Master cone selection was performed. All the root canals were obturated using zinc oxide eugenol sealer and Gutta-percha points (Protaper Gutta Percha™, Dentsply) and access was restored with dental amalgam. Post operative radiograph was taken. [Figure 2a and b].

Bottom Line: Knowledge of the most common anatomic characteristics and their possible variations is fundamental.This paper highlights endodontic management of mandibular second molar with four roots (two mesial and two distal) with one canal in each root and its cone beam computed tomography (CBCT) evaluation which was primarily done for post treatment assessment for diagnosing post-endodontic complications, at the same time confirmed our radiographic diagnosis of this variation.This also helped us portraying the anatomy of this rare variation.

View Article: PubMed Central - PubMed

Affiliation: Department of Conservative and Endodontics, Krishnadevaraya College of Dental Sciences, Bangalore, Karnataka, India.

ABSTRACT
The morphological variation in the number of roots and root canals, especially in multi-rooted teeth is a constant challenge for diagnosis and successful endodontic therapy. Knowledge of the most common anatomic characteristics and their possible variations is fundamental. Although, endodontic management of four-rooted mandibular first molars have been observed on a few occasions in the literature, to the best of our knowledge four-rooted mandibular second molars having two mesial and two distal roots have not been reported. This paper highlights endodontic management of mandibular second molar with four roots (two mesial and two distal) with one canal in each root and its cone beam computed tomography (CBCT) evaluation which was primarily done for post treatment assessment for diagnosing post-endodontic complications, at the same time confirmed our radiographic diagnosis of this variation. This also helped us portraying the anatomy of this rare variation.

No MeSH data available.