MANDIBULAR PREMOLAR WITH TWO ROOTS AND TWO ROOT CANALS: A CASE REPORT.

For the success of a root canal treatment, an in-depth knowledge of pulpal anatomy and its variations are essential. Failure to perform thorough debridement and improper obturation will lead to reinfection of the root canal, which will adversely affect the treatment outcome. Mandibular premolars usually have single root with single root canal system. Howeveranatomic variations of mandibular premolar have been reported. The clinician should be aware of the configuration of the pulp system for the successful endodontic treatment. The incidence of two roots in these teeth is quite rare. This report presents the clinical management of mandibular premolar having two roots bifurcated at the mid-root level

Mandibular pre-molars endodontic anatomy and role in sex dimorphism for Western Asia population using CBCT 3d imaging technique / Anatomía endodóntica de premolares mandibulares y papel en el dimorfismo sexual para la población de Asia Occidental utilizando la técnica de imagen 3d CBCT

SUMMARY: Cone Beam Computerized Tomography (CBCT) imaging technique can be used for identifying the root canal anatomy and its use in determining sexual dimorphism. The aim of current study was to identify the commonly found root canal morphology and gender dimorphism for mandibular pre-molars in Western Asia population according to Vertucci's classification using CBCT 3D imaging technique. On ethical approval 470 patients from Western Asia population with intact healthy mandibular first and second pre-molars were included in the study. The selected patients were sent to radiology department of Riyadh Elm University, Saudi Arabia for CBCT images. The observations recorded included: i) number of roots; and ii) type of root canal morphology based on Vertucci's classification. All the mandibular first and second pre-molars had single root both in males and females. The type of Vertucci's classification commonly observed was Type I both in males (88.94 %) and females (100 %) in mandibular first pre-molars. Similarly Type I was identified as a common root canal configuration in mandibular second pre-molars for males (82.77 %) and females (100 %). The two canal configurations Type IV and V were only observed in the males. It can be concluded from the results mandibular first and second pre-molars in the Western Asia population are single rooted with common Vertucci's Type I canal configuration in the females with rare evidence of two canals in males. Additionally CBCT is an effective technique and should be used for detection of root canals in the mandibular pre-molars which can aid dentists in providing a successful endodontic therapy.

RESUMEN: La imagen de la tomografía computarizada de haz cónico (CBCT) se puede utilizar para identificar la anatomía del conducto radicular y para determinar el dimorfismo sexual. El objetivo del estudio fue identificar la morfología del conducto radicular y el dimorfismo de sexo, comúnmente encontrados en los premolares mandibulares en la población de Asia occidental, de acuerdo con la clasificación de Vertucci, utilizando la técnica de imágenes CBCT 3D. Tras la aprobación ética, se incluyeron en el estudio 470 pacientes de la población de Asia occidental con primeros y segundos premolares mandibulares sanos intactos. Los pacientes seleccionados fueron enviados al departamento de radiología de la Universidad de Riyadh Elm, Arabia Saudita, para las imágenes CBCT. Las observaciones incluyeron: i) número de raíces; y ii) tipo de morfología del conducto radicular según la clasificación de Vertucci. Se observó solamente una raíz en los primeros y segundos premolares mandibulares tanto en hombres como en mujeres. El tipo de clasificación de Vertucci comúnmente observado fue Tipo I tanto en hombres (88,94 %) como en mujeres (100 %) en los primeros premolares mandibulares. El Tipo I se identificó como una configuración común del conducto radicular en los segundos premolares mandibulares para hombres (82,77 %) y mujeres (100 %). Ambas configuraciones de canal Tipo IV y V solo se observaron en los varones. Se puede concluir a partir de los resultados de los primeros y segundos premolares mandibulares en la población de Asia occidental, que éstos tienen una sola raíz con una configuración de canal de Vertucci Tipo I común en mujeres con una evidencia de dos canales infrecuente en los hombres. La CBCT es una técnica eficaz y debe usarse para la detección de conduc- tos radiculares en los premolares mandibulares, lo que puede ayu- dar a los dentistas a proporcionar una terapia endodóntica exitosa.

Primer premolar inferior con dos conductos y doble trayecto fistuloso: caso clínico / First lower premolar with two canals and double fistulous path: a clinical case

El tratamiento endodóntico del primer premolar inferior, cuando presenta varios conductos o varias raíces puede ser un gran desafío. En el presente trabajo se describe un caso clínico de un paciente de sexo masculino de 60 años de edad que concurre al Servicio de Guardia de la Facultad de Odontología de la Universidad de Buenos Aires (FOUBA). Al examen clínico y radiográfico se descubre la presencia de dos trayectos fistulosos que corresponden a la misma pieza dentaria con diagnóstico de absceso alveolar crónico. Concluimos que el operador debe realizar un minucioso diagnóstico, y analizar y conocer las diferentes configuraciones anatómicas para tratarlas adecuadamente, aumentando así las probabilidades de éxito del tratamiento (AU)

Endodontic treatment of the first lower premolar when it has multiple ducts or multiple roots can be a challenge. This paper describes a clinical case of a 60-year-old male patient who attends the on-call service of the School of Dentistry of the University of Buenos Aires (FOUBA). Upon clinical and radiographic examination, the presence of two sinusal tracts that corresponded to the same dental piece with a diagnosis of chronic alveolar abscess was discovered. We conclude that the operator must carry out a thorough diagnosis and analyze and understand the different anatomical configurations in order to properly treat them, thus increasing the probability of treatment success (AU)

Cone-beam computed tomography study of C-shaped root canal of mandibular premolars / 口腔疾病防治

Objective@#To investigate the incidence and morphology of C-shaped root canals in mandibular premolars by cone-beam computed tomography (CBCT) imaging, which provides a reference for clinical diagnosis and treatment.@*Methods @#The CBCT scanning data of 964 mandibular first premolars and 907 mandibular second premolars in 508 cases were collected, and the root canal morphology, incidence of C-shaped root canals, bilateral symmetry and location of radicular grooves were analyzed.@*Results@#The incidence of C-shaped root canals in mandibular first premolars was 4.1% and that in mandibular second premolars was 0.6%. The incidence of C-shaped root canals of mandibular first premolars was significantly higher than that of mandibular second premolars (χ2=25.775, P < 0.001). The symmetrical ratio of C-shaped root canals in the mandibular first premolars was 29%. There were no symmetrical C-shaped root canals in the mandibular second premolars. There were significant differences in the distribution of the C-shaped root canal configuration in the root canal (P < 0.001). The C-shaped configuration mainly existed in the middle axial and apical level of the mandibular premolars. The C2 type was more common. No C-shape was found in the coronal level of the mandibular premolars. Vertucci I single tube type was the most common type of root canal for the mandibular premolars included in this study; the incidences were 81.7% and 98.3% for the mandibular first and second premolars, respectively, and the difference was statistically significant (χ2=140.544, P < 0.001). The other root canal types of mandibular first premolars were more than those of mandibular second premolars. The incidences of Vertucci Ⅱ, Ⅲ, Ⅳ, and Ⅴ and C-shaped root canals in mandibular first premolars were significantly higher than those in mandibular second premolars. C-shaped root canal mandibular premolars had radicular grooves, and most of them were located at the mesiolingual side.@*Conclusion@# The morphology of the C-shaped root canal in mandibular premolars was complicated. CBCT can provide direct and accurate imaging evidence for clinical diagnosis and treatment.

Root canal morphology of the mandibular first premolars in a Yucatecan population using cone beam computed tomography: an in vitro study / Morfología del conducto radicular de primeros premolares mandibulares en una población yucateca usando tomografía computarizada: estudio in vitro

A successful endodontic treatment requires knowledge of the internal configuration of dental root canals. Most of the people who live in Yucatan are of Maya origin, characterized by a Mongoloid dental pattern. Because of their ethnicity, variations are expected. The purpose of this investigation is to assess the morphological characteristics and variability of this population. One hundred and five extracted first mandibular premolars of Mexican Maya population were analyzed; the sample was obtained from the Oral Surgery Clinic in the School of Dentistry at the Autonomous University of Yucatan with written informed consent. Analyses were performed by means of Cone Beam Computed Tomography. Vertucci´s Type I was the most prevalent configuration with 51.4 %, but 41 cases (39.1 %) presented a radicular groove and a C-shaped canal configuration. Overall, we documented 1, 2, 3, and 4 root canals. Mandibular first premolars are very variable in the Yucatecan population. The variability and frequency of C-shape is similar to mandibular second molars confirming the importance of the ethnic background for the endodontic treatments.

El éxito en el tratamiento endodóntico requiere el conocimiento profundo de la configuración interna del sistema de conductos radiculares. La mayoría de las personas que viven en Yucatán son de origen Maya y poseen el patron dental Mongoloide; por lo tanto, se esperan variaciones debido a su etnicidad. El propósito de esta investigación fue evaluar las características morfológicas y la variabilidad del conducto radicular en la población yucateca. Se analizaron ciento cinco primeros premolars mandibulares extraídos de pacientes provenientes de una muestra Maya mexicana; la muestra fue obtenida de la Clínica de Cirugía Oral de la Facultad de Odontología de la Universidad Autónoma de Yucatán. Con consentimiendo informado escrito. Se utilizaron Tomografías Computarizadas para el análisis de la muestra. La configuración más prevalente fue la Tipo I de Vertucci con 51,4 %. Sin embargo, 41 de 105 casos (39,1 %) presentaron un surco radicular y la configuración en forma de "C". Se documentaron casos con 1, 2, 3 y 4 conductos radiculares. Los primeros premolares mandibulares de la población Yucateca son muy variables. La variabilidad y frecuencia de conductos en forma de "C" concuerda con estudios realizados en segundos molars mandibulares en esta zona confirmando la importancia del origen étnico de las poblaciones para los tratamientos endodónticos.

Non Surgical Management Of Intra Oral Sinus In Mandibular Canine With Two Canals And Mandibular First Premolar With Two Roots: A Case Report

The root canal morphology of teeth is more often highly complex and variable. Therefore, any attempt to perform successful endodontic treatment must be preceded with thorough and detailed knowledge of the root canal morphology and its possible variations.1 The majority of mandibular canines are single rooted with one root canal. The possibility of having two canals in mandibular canines is reported to be infrequent.2,3 Mandibular first premolars have also been typically described in literature as single–rooted with incidence of extra roots to be rarely present.4 This paper describes a case report on non surgical management of intra oral sinus with presence of two root canals in mandibular canine (Vertucci Type II) and two rooted mandibular first premolar (Vertucci Type IV) in same patient, which is a rare entity.

Diagnosis and endodontic treatment in a mandibular first premolar with two canals: case report / Diagnóstico e tratamento endodôntico em primeiro pré-molar inferior com dois condutos radiculares: relato de caso

Objective: The objective of this article was to describe the diagnosis and the endodontic treatment of a mandibular first premolar with two root canals. Case report: A 67-year-old female patient presented to the dental clinic referring pain in the right mandibular first premolar. The patient reported induced pain and the sensation of "grown tooth". Clinical examination revealed a marked degree of dental abrasion associated with a slight swelling in the periapical region and positive percussion and cold tests. The radiographic examination revealed an apical radiolucency. A pulpal diagnosis of necrotic pulp and chronic perirradicular periodontitis were made. After access cavity, the canals were prepared using K-files, Gates-Glidden drills and 2.5% sodium hypochlorite. Gutta-percha cones and AH-Plus sealer were used during obturation with the lateral condensation technique. Conclusion: After a period of 23 months of follow-up, clinical and radiographic examinations revealed total regression of the lesion.

Objetivo: O objetivo deste artigo foi descrever o diagnóstico e tratamento endodôntico de um primeiro pré-molar inferior com dois canais radiculares. Relato de caso: Paciente de 67 anos de idade apresentou-se à clínica odontológica referindo dor no primeiro pré-molar inferior. A paciente relatava dor espontânea e sensação de "dente crescido". O exame clínico revelou um grau acentuado de abrasão dentária associada a ligeiro inchaço na região periapical e respostas positivas aos testes de percussão e frio. O exame radiográfico revelou a presença de uma radiolucência apical. Foi realizado o diagnóstico de polpa necrótica e periodontite perirradicular crônica. Após a realização da cavidade de acesso, os canais foram preparados utilizando limas tipo K, brocas Gates-Glidden e hipoclorito de sódio a 2,5%. Cones de guta-percha e cimento obturador AH-Plus foram utilizados na obturação com a técnica de condensação lateral. Conclusão: Após um período de 23 meses de acompanhamento, os exames clínicos e radiográficos revelaram regressão total da lesão.

The root canal therapy of mandibular first premolar with apical furcation: clinical report and literature review / 口腔疾病防治

@#Root canal therapy of mandibular first premolar is challenging for there are some variations in mandibular first premolar root canal. And it is easy to fail when there are some tiny missing root canals. This article reported a mandibular first premolar with apical furcation which was found by the combined application of X-ray and CBCT. This article also focuses on root canal exploration and instrumentation, in order to provide evidence for treatment of mandibular first premolar.

Clinical report and literature review of mandibular first premolar with three roots and three root canals / 口腔疾病防治

@#The mandibular first premolar has complicated morphology of root canal, it has more variation which increases the incidence of multiple root canals. A successful root canal therapy not only need strict cleaning, disinfection and filling, but also need a correct understanding of root canal morphology and anatomy. Otherwise there might be a risk of missing canals that resulting the failure of the therapy. Also crown closure is one of the successful elements of root canal therapy. This is a case report accompanied by a review of the literature that shows the unusual anatomy of the mandibular first molar with three roots and three root canals.

Root canal morphology and root variation of the mandibular first premolar: A study by cone-beam computed tomography / 医学研究生学报

Objective Few studies are reported on the radicular groove and root canal variation of the mandibular first premolar.This study aimed to observe the root canal system and root variation of the mandibular first premolar by cone-beam computed tomography (CBCT).Methods We selected CBCT images of 643 mandibular first premolars of 336 patients and subjected the data obtained to statistical analysis.Results Of the 643 mandibular first premolars, 637 (99.1％) had a single root and the other 6 had double roots;502 (78.1％) had a single root canal, 133 (20.7％) had two, 5 (0.78％) had three, and 3 (0.47％) presented C-shaped root canal morphology.The average length of the 643 mandibular first premolars was (13.2±1.5) mm and the mean distance from the apical foramen to the anatomical apical end of the root was (0.93±0.35) mm.Totally, 123 (19.1％) of the mandibular first premolars had a radicular groove, of which 94 (76.4％) had double root canals and the root canal systems included typesⅠ in 24 (19.5％), Ⅱ in 2 (1.6％), Ⅲ in 19 (15.4％), Ⅳ in 1 (0.8％), Ⅴ in 69 (56.1％), and Ⅶ in 3 (2.4％).Conclusion The root canal system of the mandibular first premolar has a significant variation.CBCT can reveal the complex anatomical structure of the mandibular first premolar and provide reliable evidence for the root canal treatment.

Assessment of root canal morphology of mandibular first premolars in the Indian population using spiral computed tomography: An in vitro study.

Aim: The aim of the study is to determine the root canal morphology of the mandibular first premolar teeth in an Indian population using spiral computed tomography (SCT). Materials and Methods: One hundred extracted mandibular first premolars were observed using Spiral Computed Tomography for the (i) Pattern of root canal (ii) Tooth length (iii) Position of the bifurcation of the canal (iv) Invagination of the root (v) Root thickness. The root canal morphology was classified based on Vertucci's classification. Results: Eighty percent of the teeth had a single canal, 11% of the teeth had two canals, and C-shaped canals were found in 2% of the teeth, in this study. The average length of the teeth was 21.6 mm. Fourteen percent of the teeth had mesial invagination of the root. Conclusion: The Type I root canal morphology was the most common type of root canal system in the mandibular first premolars among the Indian population in this study.