Magnificación en la terapia endodóncica mediante el microscopio operatorio / Magnification in endodontic therapy through the operatory microscope

La microendodoncia involucra la visualización a través de un microscopio operatorio de todas las fases del tratamiento de conductos y procedimientos de cirugía apical y correctiva por parte del endodoncista. Existe sobrada evidencia acerca de las mejoras que puede aportar la magnificación al tratamiento; la literatura demuestra que la capacidad del operador mejora si su visión del campo gana claridad y precisión, ambos recursos pueden ser proporcionados por el microscopio operatorio, aunado a que posibilita diagnósticos más certeros junto con mejoras en el pronóstico, lo que permite evitar posibles complicaciones. La calidad de los tratamientos endodóncicos involucra infinidad de factores, cada uno relevante en sí mismo pero, en determinados casos, el microscopio puede significar la diferencia entre un tratamiento exitoso o un fracaso clínico. En la actualidad, se ha convertido en un tema de lo más relevante, por lo que el objetivo del presente trabajo es revisar la literatura con el fin de ayudar al entendimiento basado en evidencia científica de los criterios que determinan la relevancia del uso del microscopio en el ámbito endodóncico (AU)

Microendodontics involves the visualization through an operating microscope of all phases of root canal treatment and apical and corrective surgery procedures by the endodontist. There is plenty of evidence about the improvements that magnification can provide, the literature shows that the operator's ability improves if his vision of the field gains clarity and precision, both resources can be provided by the operating microscope, added to the fact that it enables more accurate diagnoses together with improvements in the prognosis allowing to avoid possible complications. The quality of endodontic treatments involves countless factors, each relevant in itself, but in certain cases the microscope can mean the difference between a successful treatment or a clinical failure. At present, it has become a very relevant topic, so the objective of this work is to review the literature in order to help understand the criteria that determine the relevance of the use of the microscope in the endodontic field based on scientific evidence (AU)

Root canal treatment of maxillary second molar with three mesial buccal root canals: a case report and literature review / 口腔疾病防治

Objective@#To explore the key points of clinical diagnosis and treatment of three mesiobuccal root canals.@*Methods@# In the procedure of endodontic therapy for the upper left second molar with pulpitis, through root canal exploration under a dental microscope and cone beam CT (CBCT)-assisted imaging examination, it was confirmed that the left upper second molar contained 3 roots and 5 root canals, among which the third root canal existed in the mesiobuccal root. Combined with perfect root canal preparation, cleaning, disinfection, filling and minimally invasive inlay repair, the clinical symptoms were eliminated. The patients were followed up and the related literatures were reviewed. @* Results @# One- and two-year follow-ups showed that the tooth had no discomfort and could be used normally. X-ray revealed that the filling was complete, and the periapical tissue was normal. The results of the literature review showed that the incidence of three mesiobuccal root canals in maxillary second molars was 0.11%-4.2%. It is difficult to find additional root canals only by X-ray imaging. Dentists should further determine the number and anatomical shape of root canals by CBCT and operating microscopy. When there are three mesiobuccal root canals in maxillary molars, dentists should avoid overpreparation. Healthy tooth tissue is the key to good prognosis. @* Conclusion@#During root canal therapy, clinicians should consider the anatomical variation of the root canal, should always be alert to the existence of an extra root canal, and should use CBCT, operating microscopy, ultrasound and various auxiliary instruments to locate and treat the variant root canal.

A case of maxillary second premolar with 3 teeth and 4 root canals and a literature review / 口腔疾病防治

Objective @#To explore the discovery and treatment of multiple root canals in the maxillary second premolar to provide a reference for root canal therapy.@*Methods @#A case of maxillary second premolar occlusal discomfort accompanied by cold and heat stimulation pain and spontaneous pain was analyzed retrospectively.@*Results@# In this case, the number of roots and root canals in the tooth was determined by CBCT to be three roots with four canals. Root canal therapy was performed with Ni-Ti endodontic files and thermoplastic gutta-percha via root optical microscopy. The clinical symptoms disappeared after the operation.@*Conclusion@#The maxillary second premolar root canal system is complex, and additional root canals can be found and located with CBCT and optical microscopy. High-quality root canal therapy was completed.

A case report of multiple bilateral dens invaginatus in maxillary anteriors

The present report presents a case of dens invaginatus (DI) in a patient with 4 maxillary incisors. A 24-year-old female complained of swelling of the maxillary left anterior region and discoloration of the maxillary left anterior tooth. The maxillary left lateral incisor (tooth #22) showed pulp necrosis and a chronic apical abscess, and a periapical X-ray demonstrated DI on bilateral maxillary central and lateral incisors. All teeth responded to a vitality test, except tooth #22. The anatomic form of tooth #22 was similar to that of tooth #12, and both teeth had lingual pits. In addition, panoramic and periapical X-rays demonstrated root canal calcification, such as pulp stones, in the maxillary canines, first and second premolars, and the mandibular incisors, canines, and first premolars bilaterally. The patient underwent root canal treatment of tooth #22 and non-vital tooth bleaching. After a temporary filling material was removed, the invaginated mass was removed using ultrasonic tips under an operating microscope. The working length was established, and the root canal was enlarged up to #50 apical size and obturated with gutta-percha and AH 26 sealer using the continuous wave of condensation technique. Finally, non-vital bleaching was performed, and the access cavity was filled with composite resin.

Management of maxillary first molar with six canals using operating microscope

The purpose of this article was to highlight the importance of having a thorough knowledge about the root canal morphology. This case report highlights the unusual anatomy of a maxillary first molar with three mesiobuccal (MB) canals, two palatal canals, and one distobuccal canal which is extremely rare. The use of operating microscope was crucial, both for the detection and for the management of the additional canals. The use of surgical operating microscope and digital radiograph showed that MB root had Type 3-1 of Gulabivala classification and palatal canal showed Vertucci's Type II canal morphology This report describes and discusses the identification of variation in canal morphology of maxillary first molar and the use of latest adjuncts in successfully diagnosing and negotiating them.

Role of the operating microscope in diagnosis and treatment of endodontic diseases / 中华口腔医学杂志

The excellent magnification and illumination of the operating microscope not only helps to improve the quality of conventional root canal therapy, but also plays an important role in the diagnosis and treatment of the difficult cases of endodontic diseases. It has an irreplaceable position over other equipment especially for the treatment of root canal therapy complications and the apical surgery. The structure and operation of the operating microscope are relatively complicated. The proficiency of the dentist may influence the evaluation of its clinical application effect. Based on the review of literature and author's clinical experience, this paper evaluates the role of operating microscope in the diagnosis and treatment of endodontic diseases.

Evaluation of the use of dental operating microscope in the treatment of calcified canals / 口腔疾病防治

Objective@#To evaluate the use of dental operating microscope in treating calcified canals. @*Methods@#369 calcified canals were treated with C-Pilot files and ethylene diamine tetraacetic acid (EDTA) under dental operating microscope. The canals were grouped based on the calcified teeth site and calcified location in canals, and then the success rates of negotiating were analyzed with χ2 test.@*Results @#310 of 369 calcified canals were negotiated under dental operating microscope, the negotiating rate was 84.01%. For the anterior, premolar and molar, the negotiating rate were 94.78%, 85.98%, and 74.15% respectively. There were significant differences between anterior and molar teeth (χ2 = 19.658, P<0.05). When the calcification was located in straight canals or above the root canal curvature, canals were negotiated with a success rate of 96.85%. However, it decreased to 39.76% when the calcified portion located below the root canal curvature (χ2 = 156.113, P<0.05).@*Conclusion @# It is an effective way to use dental operating microscope and C-Pilot files to treat calcified canals, but the therapeutic effects might be affected by sites of the teeth and the calcified location in canals.

Minimally invasive root canal therapy / 口腔疾病防治

@#Minimally invasive root canal therapy should be defined as a discipline which adhere to a concept of preserving the healthy tooth structure as much as possible during all the root canal therapy procedure. In the past 15 years, the concept of minimally invasive has spread and developed fast throughout the diagnosis and treatment of endodontics, which made the root canal therapy (RCT) procedure safer, more accurate and efficient. Minimally invasive endodontics rely on the development of various kinds of therapeutic devices and materials, including the 3D image auxiliary equipment, operation microscope, the NiTi instrument systems and the disinfection and obturation material. Minimally invasive endodontics is a therapeutic concept of the modern root canal therapy which redefined the standard of what a successful RCT is.

Use of dental operating microscope in non-surgical endodontic treatment / 口腔疾病防治

@#Dental operating microscope is recommended to complicated root canal therapy, for it could provide increased lighting and superior magnification, so that the survival rate of tooth is highly increased. More refined access of cavity preparation, canal cleaning, shaping and obturating are realized under microscope. This article combined literature reviews with the writers’ clinical experience, and it aims at helping clinicians to improve their ability to more accurately performance and minimally invasive endodontic procedures, such as locating hidden canals obstructed by calcifications, canals reduced in size, removing materials, reducing ledge formation, apical transportation, and repairing perforations.

A maxillary first molar with two palatal roots and an accessory canal diagnosed by CBCT / 实用口腔医学杂志

A maxillary first molar with 2 distinct palatal roots and an accessory canal was diagnosed by CBCT and microscope.An enamel protuberance at the cervical area was found.A properly usage of CBCT and microscope is helpful for the diagnosis and treatment of tooth with complex root canal system.

Application and thinking of cone beam computed tomography directing technology on teaching of dental microscope treatment to endodontic disease / 中华医学教育探索杂志

Endodontic treatment with the use of dental operating microscope is a difficult part in teaching. We have applied cone beam computed tomography (CBCT) guided technology for microendodontic training of dental students who are in their 5th year of the 7 year course to pursue their master's degree. The process of teaching is constituted of preoperative analysis, operation guided by CBCT, postoperative therapeutic evaluation. And the result of teaching quality is acquired by questionnaire. This method improved student's capacities of analysis and solution in intractable cases and greatly motivated students' participa-tion, as well as promoting their learning efficiency. The application of this technique in teaching process compensates the deficiency of traditional teaching method by shaking off the fetters of experience-dependent pattern in the endodontic microscope teaching, and is worth to be popularized in endodontic education.

Presence of Mesiobuccal 2 and Mesiobuccal 3 Canal in Maxillary First Molar: An Illusion.

Successful endodontic treatment involves a proper access cavity preparation, biomechanical principles, and three-dimensional obturation. Thus, the clinician should have a through knowledge of anatomy and morphology of the root canal system. Failure in root canal therapy may be due to inability in locating the canal and its proper debridement. The configuration and a number of root canals in the maxillary first molars have been discussed for more than half a century. Maxillary first molars commonly present with three roots and three canals, with a second mesiobuccal canal (MB2) and (MB3). The current case reports describe the presence of extra canals MB2 and MB3 in a maxillary first molar.

Endodontic management of a maxillary first molar with three roots and seven root canals with the aid of cone-beam computed tomography

Variation in root canal morphology, especially in maxillary first molar presents a constant challenge for a clinician in their detection and management. This case report describes the successful root canal treatment of a three rooted right maxillary first molar presenting with three canals each in the mesiobuccal and distobuccal roots and one canal in the palatal root. The clinical detection of this morphologic aberration was made using a dental operating microscope, and the canal configuration was established after correlating and computing the clinical, radiographic and cone-beam computed tomography (CBCT) scan findings. CBCT images confirmed the configuration of the canals in the mesiobuccal and distobuccal roots to be Al-Qudah and Awawdeh type (3-2) and type (3-2-1), respectively, whereas the palatal root had a Vertucci type I canal pattern. This report reaffirms the importance of careful examination of the floor of the pulp chamber with a dental operating microscope and the use of multiangled preoperative radiographs along with advanced diagnostic aids such as CBCT in identification and successful management of aberrant canal morphologies.

The Use of Dentascan to Diagnose and Treat Mandibular Premolar with Multiple Canals.

Introduction: For successful endodontic therapy it is vital to have thorough knowledge of morphology of the root canal system and its variations besides proficient aseptic intraoperative condition. Mandibular second premolars are usually single rooted tooth with single root canal system. The incidence of the number of roots and the number of canals varies greatly in the literature. Methods and Results: This case report describes an unusual case of mandibular second premolar with two roots and five root canals. This was confirmed by radiographs, dentascan and dental operating microscope (DOM), and was successfully treated using K files system, guttapercha and AH plus sealer in lateral condensation manner. Conclusion: The clinical significance of this case report is that the precise awareness about the aberrant morphologies of the root canal system can only be appreciated when advanced radiographic techniques, magnification and illumination are used to treat such type of cases.

The Role of Magnification In Endodontics.

Until recently, endodontic therapy was performed using tactile sensitivity, and the only way to see inside the root canal system was to take a radiograph. Performing endodontic therapy entailed ‘‘working blind,’’ that is, most of the effort was taken using only tactile skills with minimum visual information available. Before the introduction of magnification devices the presence of a problem (a ledge, a perforation, a blockage, a broken instrument) was only ‘‘felt,’’ and the clinical management of the problem was never predictable and depended on happenstance. With the recent advances of magnification devices with increased magnification and illumination there is improved technical accuracy and performance. It also allows the dentist to sit in an upright, neutral, and balanced posture, and has proven to be of great value in aiding documentation. This article highlights the role of magnification, types of magnification devices and their clinical application in endodontics.

Endodontic Management of Maxillary Molar With Six Root Canals - A Case Report.

The aim of the present case report is to describe the unusual root canal anatomy of maxillary first molar with six canals, three in mesiobuccal root, two in distobuccal root and one in palatal root. This article highlights the importance of modifying the access opening and magnification in location of the additional canal orifices.

Mandibular second molar with type 1-2 canal of mesial root:Report of one case / 实用口腔医学杂志

The root canal system of mandibular second molar is complex.This article presents one case with type 1-2 mesial root canal of mandibular second molar.The canal was treated by warm gutta percha,and conformed by X-ray examination and dental operating microscopy.

Location of three canals in the mesiobuccal root of the maxillary first molar

Introduction:The knowledge on the complex anatomy of the maxillary first molar and location of extra canals are essential for diagnosis and endodontic treatment success. Objective:The purpose of this study was to report a clinical case showing a varied number of root canals in maxillary molars with the aid of the operating microscope (OM). Case report: The endodontic retreatment of the right maxillary first molar with unusual anatomical variation was performed, displaying three canals in the mesiobuccal root (MB), a root canal in the distobuccal root (DV) and a root canal in the palatal root (P). To remove the resin core inside pulp chamber with and without the aid of dental operating microscope, a high-speed drill and ultrasonic tip (diamond round) was used, respectively, for the refinement of the pulp chamber walls. The dental operating microscopewas used during the access surgery, location, negotiation of canals and checking of the completion of all stages of the retreatment. Subsequently, the cleaning, shaping and filling of the root canal system was completed. The presence of three canals in the mesiobuccal root, one in the distobuccal root and one in the palatal root was found. Conclusion: Variations in the number of canals could be confirmed during the surgery access in endodontic retreatment cases with the aid of dental operating microscope.

Microscope-aided endodontic treatment of maxillary first premolars with three roots: A case series.

Maxillary premolars have a highly variable root canal morphology. However, the presence of three roots is a rare occurrence. This clinical article describes the unusual anatomy detected in maxillary premolars during routine endodontic treatment using microscope. The diagnosis and clinical management of maxillary first premolars with three roots and canals using radiographic interpretation, access cavity modification and visual enhancement with operative microscopes is discussed in the article.

Unuaul Mazillary First Molar With Two Palatal Canals Located Under Operating Microscope.

Knowledge of the anatomical variations, particularly concerning the location and treatment of all canals is very important for the success of the endodontic therapy. Modifications in endodontic access and detection techniques, along with advancements in illumination and magnification technology, have aided in the location and treatment of extra canals in teeth. A case report is presented regarding a maxillary first molar with 5 root canals, two in mesiobuccal root , two in palatal root and one canal in distobuccal root located under Operating Microscope. The morphology is atypical because it is characterized by a single palatal root with 2 canals with separate orifices joining in the apical third. This report serves to remind clinicians that such anatomical variations should be taken into account during endodontic treatment of the maxillary molars.