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THE FOURTH CANAL IN             MANDIBULAR FIRST             MOLARS- Case reportsRukoma A.M; DDS, MDent (Restorative Denti...
Introduction The success rates of RCT among others  depend on practitioners’ knowledge of the  internal dental/root morph...
 The   use of  Magnification  adequate lighting and  modified accessmay assist in accurate location of the root canals...
   There is a significant difference in location of    canals between using and not using visual aid.   Buhrley et al (2...
Visual aidsDental loop with light   A Dentist usingsource                   surgical microscope
Dental handpice with laser light
Modified dental access cavity
Studies show mandibular 1st molars having  variable number of root canals.   3-4 canals-majority (Fabra-Compos, 1985;    ...
   With increasing reports of aberrant canal    morphology, dental practitioners need to be    extra cautious and think o...
Case report-1On 30th may, 2011, a 26 yrs F, patient reported at our clinic with the main complain of;   severe toothache ...
On examination,   a big and deep cavity on bucco-occlusal    surfaces of tooth #46 was revealed.   Periapical x-ray show...
Upon excavation and access cavity preparation,   clearly and separate two root canal orifices were    seen in the distal ...
Figures 1&2 showing k-files in the rootcanalsFig.1 k-files in 4 different   fig. 2: two k-files in theroot canals         ...
   All canals were prepared and cleaned at    working length of 21.5 mm and Master Apical    File (MAF) size 35.   Obtur...
Case report- 2   On 7th June, 2011, a 16-yrs, M, patient    presented to KDC with a history of severe    toothache on the...
   Clinical examination revealed a big and deep    cavity involving occlusal, buccal and distal    surfaces of tooth #46....
   Due to direct visualization of the access cavity    and floor of PC, two clearly visible canals    were seen in the di...
Figures 3: showing k-files in the root canals
   The disto-lingual canal was the smallest of all    canals enlarged up to size 20 (MAF), the rest    of the canals were...
Discussion   In both two cases the second distal canals were    easily located- because of location and extent    of the ...
   The observation that the reported two cases    with four root canals were just within 8 days    suggest that, there is...
Conclusion   It is likely there is a substantial number of    mandibular 1st molar teeth with two canals in    the distal...
Recommendations   Clinicians must always attempt to look for the    extra- canals when attending mandibular 1st    molars...
References   Al- Nazhal. S, (1999). Incidence of fourth canal in the root    canal treated mandibular first molars in Sau...
   Fabra-Compos, (1985). Unusual root anatomy of manibular    first molar J Endod 12, 568-72.   Martinez-Bema A and Band...
For more readings about dentistry, visit  http://rukomadentalanswers.blogspot.comSide bars on blog postings can also enhan...
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The fourth canal in mandibular first molars case

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The fourth canal in mandibular first molars case

  1. 1. THE FOURTH CANAL IN MANDIBULAR FIRST MOLARS- Case reportsRukoma A.M; DDS, MDent (Restorative Dentistry) 2011
  2. 2. Introduction The success rates of RCT among others depend on practitioners’ knowledge of the internal dental/root morphology that allows:- for accurate location of the canals proper debridement and cleaning together with adequate obturation of the canals and filling of the access cavity.
  3. 3.  The use of Magnification adequate lighting and modified accessmay assist in accurate location of the root canals (Amauri et al., 2006).
  4. 4.  There is a significant difference in location of canals between using and not using visual aid. Buhrley et al (2003) reported the incidence of finding extra canal in maxillary first molars to be;  17%-without visual aid  63%-when using dental loupes  71%-operating microscope
  5. 5. Visual aidsDental loop with light A Dentist usingsource surgical microscope
  6. 6. Dental handpice with laser light
  7. 7. Modified dental access cavity
  8. 8. Studies show mandibular 1st molars having variable number of root canals. 3-4 canals-majority (Fabra-Compos, 1985; Walker R. 1988; Zaatar el al,1997 and Al- Nazhal, 2004) 5 canal (Baugh, and James, 2004) 6 canals (Martinez-Berna and Bandanelli 1985)
  9. 9.  With increasing reports of aberrant canal morphology, dental practitioners need to be extra cautious and think of employing dental visual aids when dealing with these teeth An unidentified, and therefore uncleaned, canal can be a major cause of failure.
  10. 10. Case report-1On 30th may, 2011, a 26 yrs F, patient reported at our clinic with the main complain of; severe toothache not responding to panadol for three days pain was disturbing her sleep.
  11. 11. On examination, a big and deep cavity on bucco-occlusal surfaces of tooth #46 was revealed. Periapical x-ray showed dental pulp exposure.
  12. 12. Upon excavation and access cavity preparation, clearly and separate two root canal orifices were seen in the distal root as well as in the mesial root. The canals were easily penetrated by small K-files (fig.1). the two canals in distal root was located on the buccal and lingual part of the root (fig.2).
  13. 13. Figures 1&2 showing k-files in the rootcanalsFig.1 k-files in 4 different fig. 2: two k-files in theroot canals distal 2 root canals
  14. 14.  All canals were prepared and cleaned at working length of 21.5 mm and Master Apical File (MAF) size 35. Obturation was done the same day (single visit technique) and access cavity filled. As up to now, the patient is quite well.
  15. 15. Case report- 2 On 7th June, 2011, a 16-yrs, M, patient presented to KDC with a history of severe toothache on the lower right jaw for 2 days. The pain was worse during night hrs radiating up the same side of his face and ear.
  16. 16.  Clinical examination revealed a big and deep cavity involving occlusal, buccal and distal surfaces of tooth #46. Periapical x-ray revealed dental pulp exposure with small apical radioluscence around the apex of the distal root of 46.
  17. 17.  Due to direct visualization of the access cavity and floor of PC, two clearly visible canals were seen in the distal root and two in mesial root. In both roots the canals were located on the buccal and lingual sides (fig.3). All canals were easily accessible using k-file #10.
  18. 18. Figures 3: showing k-files in the root canals
  19. 19.  The disto-lingual canal was the smallest of all canals enlarged up to size 20 (MAF), the rest of the canals were enlarged up to MAF size 35. Obturation of the all canals was done after three days and patient is doing fine.
  20. 20. Discussion In both two cases the second distal canals were easily located- because of location and extent of the cavity. This observation indicates that with modifies access cavity a forth canal is likely to be found.
  21. 21.  The observation that the reported two cases with four root canals were just within 8 days suggest that, there is substantial number of mandibular first molars with four canals. This is in agreement with Al-Zantal (2004), who said that, “in general, the second canal in distal root is the usual normal”.
  22. 22. Conclusion It is likely there is a substantial number of mandibular 1st molar teeth with two canals in the distal root.
  23. 23. Recommendations Clinicians must always attempt to look for the extra- canals when attending mandibular 1st molars visual aids are needed when doing root treatment Researches are needed to find out the number of root canals in mandibular 1st molars in Zambia population
  24. 24. References Al- Nazhal. S, (1999). Incidence of fourth canal in the root canal treated mandibular first molars in Saudi Arabian sub- population, Int Endod J, 32, 49-52 Amauri F, Fabiana G, Luís C C. (2006) Root canal therapy of a maxillary first molar with five root canals: case report Braz Dent J 17. Baugh, D. and James (2004). Middle Mesial Canal of the Mandibular First Molar: J. Enod 30, 185 Buhrley L J, Barrows M J, BeGole E A. Effect of magnification on locating the MB2 canal in maxillary molars. J Endod 2003; 28: 324–327.
  25. 25.  Fabra-Compos, (1985). Unusual root anatomy of manibular first molar J Endod 12, 568-72. Martinez-Bema A and Bandanelli P. (1985). Mandibular first molar with six root canals. J. Endod 11, 348-52 Walker R. (1988). Root form and canal anatomy of mandibular first molar in a southern Chinese Population. Endod. and Dent. Traumatol. 4, 19-22 Zaatar E I. 1, , Al-Kandari A M 2, Alhomaidah S, and Al Yasin I M. (1997). Frequency of endodontic treatment in Kuwait: Radiographic evaluation of 846 endodontically treated teeth J Endod 23, 453-456.
  26. 26. For more readings about dentistry, visit http://rukomadentalanswers.blogspot.comSide bars on blog postings can also enhance your knowledge on dentistry

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