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mandibular 2 premolar tooth anatomy and endodontics management of premolar

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  1. 1. MANDIBULAR <br />2 PRE MOLAR<br />BY<br />O.R.GANESH MURTHI <br />M.Sc.D ENDO<br />
  2. 2. OUT LINE<br /><ul><li> INTRODUCTION
  3. 3. EXTERNAL ANATOMY
  4. 4. INTERNAL ANATOMY
  5. 5. VARIATIONS
  6. 6. ANOMALIES
  7. 7. ENDODONTIC </li></ul> CORRELATION<br />
  8. 8. INTRODUCTION<br /><ul><li> The term premolar is used to </li></ul>designate any tooth in the permanent <br />dentition that replaces a primary <br />molar.<br /><ul><li>fifth tooth from midline in the </li></ul>mandible quadrant.<br /><ul><li> They assist canine in shearing and </li></ul>support corners of the mouth from <br />sagging.<br />
  9. 9. Mandibular 2nd premolar<br />Average time of eruption : 11 to 12 years<br />Average age of calcification : 13 to 14 years<br />Average length : 22.3 mm<br />
  10. 10. Significance of average time of eruption,ageof <br />calcification,toothlength & root curvature: <br />IT HELPS IN DIAGNOSIS AND TREATMENT PLAN <br />TREATMENT IS DIFFERENT IN ADULT AND YOUNG<br />NECROTIC PULP<br />RCT<br />ADULT <br />IRREVERSIBLE <br />PULPITIS<br />
  11. 11. YOUNG<br />Irreversible Pulpit's <br />Necrotic Pulp<br />Reversible Pulpit's<br />Pulp Capping or <br />Pulpotomy<br />Closed Apex<br />Open Apex<br />Apexification <br />Obturation<br />Apexogenesis<br />RCT<br />
  12. 12. Mandibular 2nd premolar<br />Average Length : 21.4 mm <br />Maximum Length : 23.7 mm<br />Minimum Length : 19.1 mm<br />Range : 4.6 mm<br />
  13. 13. Mandibular 2nd premolar<br />IMPORTANCE<br /> It helps in the determining the working length and better assumption of the radiograph<br />Consideration must be given to the mental foramen which lies in close proximity to the apex. Avoid over instrumentation and overfill.<br />
  14. 14. Mandibular 2nd premolar<br />Buccal aspect<br />Long pointed buccal cusp in the occlusal profile<br />Mesial cusp ridge is shorter than distal <br />Cusp tip is a little mesial to the tooth midline<br />
  15. 15. Mandibular 2nd premolar<br />Buccal aspect<br />Mesial & Distal outlines are markedly converging<br />Cervical line is flat mesiodistal compared to that of canine<br />Root is conical with pointed apex<br />
  16. 16. Mandibular 2nd premolar<br />Lingual aspect<br />mesiodistal diameter = that from Buccal aspect<br />Occlusal surface cannot be seen fully<br />Occlusal plane is perpendicular to tooth Axis<br />
  17. 17. Mandibular 2nd premolar<br />2 lingual cusps (most commonly)<br /> • Mesiolingual – major, <br /> 2/3 MD diameter, <br /> same height as Buccal<br /> • Distolingual – minor<br />Lingual groove<br />2/3<br />
  18. 18. Mandibular 2nd premolar<br />Mesial aspect<br />Triangular ridges of Buccal <br />and Mesio lingual cusps don’t not form a continuous crest<br />Distal aspect<br />Both lingual cusps are <br />seen<br />
  19. 19. Mandibular 2nd premolar<br />Occlusal aspect<br />Square profile <br />Mesial & Lingual profiles are parallel<br />More than half of Buccal surface is visible<br />Buccal ridge is less prominent than that of mandibular 1st premolar<br />Mesial & Distal Marginal ridges are equal in length<br />
  20. 20. Mandibular 2nd premolar<br />Occlusal view<br />Mesial & Distal triangular fossae<br />each contains<br />• A pit<br />• Mesiobuccal & Distobuccal grooves<br />M<br />D<br />
  21. 21. Mandibular 2nd premolar<br />Occlusal view<br />Grooves (Y shape meet at the central pit)<br />• Mesial groove separates Buccal & Mesiolingual triangular ridges – runs obliquely<br />• Lingual groove separates lingual cusps<br />• Distal groove separates Buccal & Distolingual triangular ridges<br />B<br />ML<br />DL<br />
  22. 22. Mandibular 2nd premolar<br />Pulp<br /> Buccolingual section<br />• Pulp chamber is<br />wider<br />• Pulp horns are of<br />equal height<br />
  23. 23. Mandibular 2nd premolar<br />PULP CHAMBER<br /><ul><li> Mesiodistal width - narrow
  24. 24. Buccolingual width - wide
  25. 25. Lingual horn is more prominent </li></ul> under a well developed lingual <br /> cusp<br /><ul><li> 30 lingual tilt
  26. 26. Cross section – ovoid with greater </li></ul> diameter in buccolingually <br />
  27. 27. Mandibular 2nd premolar<br />
  28. 28. Mandibular 2nd premolar<br />ROOTS AND ROOT CANALS<br />The Mandibular second premolar resembles the first premolar, but the lingual canal is present only occasionally.<br />The root canal is oval in cross-section and rather straight with only a slight distal curvature in some canals <br />
  29. 29. Mandibular 2nd premolar<br />ROOTS AND ROOT CANALS<br />
  30. 30. Mandibular 2nd premolar<br />ROOTS AND ROOT CANALS<br />1 Canal 1 foramen - 85.5 %<br />1 canal 2 foramen - 11.5 %<br />2 Canal 1 foramen - 1.5 %<br />3 canal - 0.5 %<br />Distal curve – 40 %<br />Straight – 39 %<br />Buccal curve – 11 %<br />Lingual curve – 10 %<br />
  31. 31. ROOTS AND ROOT CANALS<br />One root canal dividing in <br />to two at apex<br />Single canal that has divided and cross over at the apex<br />
  32. 32. ROOT CANAL ORIFICES <br />1 CANAL SEPARATE IN<br />TO 2 CANALS<br />DIVISION IS BUCCAL <br />AND LINGUAL<br />LINGUAL CANAL SPLITS<br />FROM THE MAIN CANAL<br />AT SHARP ANGLE IT IS <br />VISUAL CONFIGURATION <br />AS LOWER CASE LETTER h<br />BUCCAL CANAL IS STRAIGHT<br />PORTION OF THE h<br />
  33. 33. ACCESSORY CANALS<br />Mostly found in the apical third Lateral canals may be found in 44.3% cases Usually a good biomechanics preparation cleanses the canal well and is filled with the sealer during Obturation.<br />The ability to cleanse and seal these canals have an impact on the prognosis<br />
  34. 34. Mandibular 2nd premolar<br />Note :<br />• When only one canal is present , it is usually found in the center of the access preparation. <br /><ul><li>If only one canal is found, but it is not in the centre of the tooth, it is probable that another canal is present</li></li></ul><li>ROOT CANAL ORIFICES <br />1 CANAL PRESENT<br />LOCATED IN THE CENTER <br />OF THE ACCESS<br /> PERPARATION<br />NOT LOCATED IN CENTER<br />OF THE ROOT<br />ANOTHER ORIFICES PROBELY<br /> EXISTS<br />CLINICIAN SHOULD SEARECH<br /> FOR OPPOSITE SITE<br />
  35. 35. Mandibular 2nd premolar<br />Anatomic relationships in situ<br />The mental canal and foramen are close to the root apex Radiograph appearance may shows peiapical pathosis<br />
  36. 36. Anatomic relationships in situ<br />Avoid over instrumentation and overfill When viewing an x-ray of this area, the mental foramen is sometimes misdiagnosed as a premolar abscess. Therefore, before performing root canal therapy, make sure all diagnostic tests confirm your finding.<br />
  37. 37. FAST BREAK<br /> When numerous canalare present, the preoperative radiograph often indicates a "fast break." This appears as a relatively patent canal space in the coronal portion of the tooth that suddenly disappears.<br />
  38. 38. FAST BREAK<br />Note: <br />If a straight-on preoperative radiograph of a Mandibular 2 premolar shows the pulp canal disappearing in mid-root, this is an important indication that two canals are present.<br />
  39. 39. Mandibular 2nd premolar<br />The mandibular second premolar is similar to the first premolar, with the following differences:<br /><ul><li> The lingual pulp horn usually is </li></ul> larger<br /><ul><li> The root and root canal are more </li></ul> often oval than round<br /><ul><li> The pulp chamber is wider </li></ul> buccolingually<br />
  40. 40. THE ACCESS CAVITY <br />The access cavity form for the Mandibular second premolar varies in at least two ways in its external anatomy.<br />1.The crown typically has a smaller lingual inclination less extension up the buccal cusp incline is required to achieve straight-line access. <br />2. The lingual half of the tooth is more fully developed; therefore the lingual access extension is typically halfway up the lingual cusp incline. <br />
  41. 41. THE ACCESS CAVITY <br />The Mandibular second premolar can have two lingual cusps, sometimes of equal size. <br />When this occurs, the access preparation is centered mesiodistally on a line connecting the buccal cusp and the lingual groove between the lingual cusp tips. <br />
  42. 42. THE ACCESS CAVITY <br />Buccolingual ovoid outline form reflects the anatomy of the pulp chamber and position of the centrally located canal.<br />
  43. 43. THE ACCESS CAVITY <br /><ul><li>The lingual portion should be prepared well for a straight line access and location of lingual canal.</li></li></ul><li>CROSS SECTIONAL IN CERVICAL LEVEL<br />the pulp is large in a young<br />tooth, very wide in the Buccolingual dimension.<br />Debridement of the chamber is completed during coronal cavity preparation with a round bur<br />
  44. 44. CROSS SECTIONAL IN MIDROOT <br />LEVEL AND APICAL<br />Midroot level: the canal continues to be long ovoid and requires perimeter filing <br />Apical third level: the canals, generally round, are shaped into round, tapered preparations.<br />Preparation terminates at the cementodentinal<br />junction, 0.5 to 1.0 mm from the radiographic<br />apex.<br />
  45. 45. MANDIBULAR 2 PREMOLAR TEETH<br />ERRORS IN CAVITY PREPARATION<br />PERFORATION<br />at the disto gingival caused by failure to recognize that the premolar has tilted to the distal<br />
  46. 46. MANDIBULAR 2 PREMOLAR TEETH ERRORS IN CAVITY PREPARATION<br />INCOMPLETE<br />preparation and possible instrument breakage caused by total loss of instrument control. <br />Use only occlusal access, never buccal or<br />proximal access.<br />
  47. 47. MANDIBULAR 2 PREMOLAR TEETH<br />ERRORS IN CAVITY PREPARATION<br />BIFURCATION<br />Of a canal completely missed,<br />caused by failure to adequately explore the canal with a curved instrument<br />
  48. 48. MANDIBULAR 2 PREMOLAR TEETH<br />ERRORS IN CAVITY PREPARATION<br />APICAL PERFORATION<br />Of an invitingly straight<br />conical canal. Failure to establish the exact length of the tooth leads to trephination of the foramen<br />
  49. 49. MANDIBULAR 2 PREMOLAR TEETH<br />ERRORS IN CAVITY PREPARATION<br />PERFORATION <br />at the apical curvature caused by failure to recognize, by exploration, buccal curvature.<br />A standard bucco lingual radiograph will not<br />show buccal or lingual curvature<br />
  50. 50. Mandibular 2nd premolar<br />Anomalies<br /><ul><li> Dens invaginatus
  51. 51. Dens evaginatus
  52. 52. Gemination
  53. 53. Dilaceration </li></li></ul><li>DENS INVAGINATUS<br /><ul><li> Dens invaginatus is a malformation </li></ul>of teeth probably resulting from an <br />infolding of the dental papilla during <br />tooth development.<br /><ul><li> Affected teeth show a deep infolding </li></ul>of enamel and dentine.<br /><ul><li> Occurs before calcification of the </li></ul>teeth.<br /><ul><li> Also known as dens in dente</li></li></ul><li>TREATMENT OF DENS INVAGINATUS<br /><ul><li>The treatment modalities depend on the degree of complexity of its anatomy.
  54. 54. They include nonsurgical endodontic treatment, endodontic surgery and extraction.
  55. 55. In cases in which there is an immature apex, calcium hydroxide is used to stimulate apexification</li></li></ul><li>DENS EVAGINATUS<br /><ul><li>Dens evaginatus is a developmental anomaly that manifests as a tubercle emerging from the surface of the affected tooth.
  56. 56. It occurs most frequently in the premolars.
  57. 57. Higher prevalence among people of Mongoloid origin.</li></li></ul><li>DENS EVAGINATUS<br />
  58. 58. Clinical importance<br /><ul><li>Fracture or wear of the tubercle could lead to pulp necrosis before root formation is complete.
  59. 59. Various prophylactic treatments like selective grinding, application of resin, restorations and partial Pulpotomy can be done.
  60. 60. If there is complete pulpal necrosis in an immature tooth, MTA can be used in the apex followed by endodontic treatment.</li></li></ul><li>Mandibular second premolar with <br />three root canals<br />Report of a case<br />
  61. 61. A 20- year-old male with non contributory medical history was referred to the clinics of the SaudiBoard in Advanced Restorative at the Faculty of Dentistry, for evaluation of root canal therapy of a mandibular 2 premolar. <br />Clinical examination revealed<br />that the tooth responded positively to percussion but not to palpation.<br /> Radiographic examination revealed short and inadequate root canal filling<br />
  62. 62. Pre-operative radiograph showing the poor root canal filling.<br />
  63. 63. The tooth was isolated with rubber<br />dam, the old amalgam filling was removed and the access cavity preparation was established. <br />Three canals were located,<br />buccally, lingually and an extra canal in the middle.<br />The working length was checked radiographically<br />
  64. 64. Working length radiograph showing files in the three root canals.<br />
  65. 65. The canals were conventionally instrumented to a # 35K file using crown-down pressureless technique, irrigated with 5.25 percent sodium hypochlorite, dried with sterile paper points and sealed with calcium hydroxide paste The access opening was closed with Cavit. <br />The patient returned asymptomatic after 1 week, the tooth was isolated with rubber dam; the canals were instrumented with file #35 and irrigated with sodium hypochlorite to remove all the remnants of the calcium hydroxide, and then dried with paper<br />points<br />
  66. 66. Master cone was selected and the canals were filled with gutta-percha and AH26 sealer cement using lateral condensation.<br />Access opening was sealed with amalgam restoration. Post-operative radiograph was taken to confirm<br />the quality of the filling .The patient was referred to the prosthetic clinic for crown construction.<br />
  67. 67. Obturation of the three root canals<br />
  68. 68. DISCUSSION<br />Location and thorough instrumentation of all the canals in the root of a diseased tooth normally ensure success of the endodontic therapy. <br />Presented is a case of mandibular second premolar which was referred for endodontic therapy. Clinical and radiographicexamination revealed inadequate root canal filling. Three canals were located. Endodontic therapy was performed under aseptic<br />conditions<br />
  69. 69. References <br /><ul><li>Endodontics 5th Edition - Ingle & Bakland
  70. 70. Pathways Of The Pulp 6th Edition - Cohen
  71. 71. Endodontic Practice 11th Edition</li></ul>Grossman<br /><ul><li> A Textbook Of Oral Pathology - Shafer
  72. 72. Wheeler’s Dental Anatomy, Physiology </li></ul>and Occlusion 7th Edition – Ash<br /><ul><li> Colors Atlas of Endodontics - William T. </li></ul>Johnson<br /><ul><li> Medical principles and practice</li></li></ul><li>THANK YOU ALL<br />

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