| SDJ |
| Editorial Board |
| Advisory Board |
| Information for authors |
| Submit manuscript |
| Subscribe to SDJ |
| Search SDJ |
| About SDJ |
| SDJ Current Issue |
| Journal Archives |
| 2010-22 |
| 22-1 |
ISSN (Print) 1013-9052
EISSN 1658-3558
The Saudi Dental Journal,
P.O. Box 52500,
Riyadh 11563,
Kingdom of Saudi Arabia
P.O. Box 52500,
Riyadh 11563,
Kingdom of Saudi Arabia
| Tel. |
966-1-467-7328 |
| Fax. |
933-1-467-7308 / 966-1-467-7534 |
| Email |
saudidj@ksu.edu.sa |
|
Five-year follow-up of a root canal treatment of a mandibular second premolar with three root canals: A case report
Ghanim Ali AlMannai, BDS, MMedSc, Khalid Mohd Alasmakh, BDS, MSc Dental Department, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
Thorough knowledge of root canal morphology is a prerequisite for successful root canal treatment. Although the possibility of finding three root canals in the mandibular second premolar is relatively small, it should not be overlooked. The aim of this paper was to report a five-year follow-up of a root canal treatment performed on a mandibular premolar with two roots and three root canals.
Requirements for a successful root canal therapy are thoroughly cleaned, shaped and three-dimensional tightly-sealed canal.1 Thorough knowledge of root canal morphology is a prerequisite for successful endodontic treatment because failure to locate any root canal will leave an uncleaned canal which will compromise the treatment outcome.2 The mandibular second premolar is known to have slight anatomical variations in the number of roots and root canals. The most common anatomical configuration for the mandibular second premolar is a single root and a single root canal. The frequency of having a single root ranges between 96.6% and 100% 3,4 and the frequency of having a single root canal ranges between 71% and 98.8%.4,5 This high percentage of single root/root canals in the mandibular second premolar is the reason why most practitioners generally treat this tooth as a single-rooted tooth with a single root canal. Although having a single root and root canal is the most common mandibular second premolar anatomical root configuration, anatomical variations must always be kept in mind when treating this tooth. In fact, practitioners should always keep in mind that this tooth could have more than one root/root canal with two roots in about 4.7% of the cases 6 and up to 13.4% of the cases could have more than two root canals.7
Mandibular second premolar with three root canals is well documented in several case reports.8-11 The anatomical variation of mandibular premolar could be the presence of more than three root canals, and indeed cases have been reported with four 12-14 and five 15 root canals. The aim of this case report was to report a five year follow-up of a root canal treatment of a mandibular second premolar with three root canals.
A 28-year-old female patient with a non-contributory medical history was referred to the Endodontic Section of the Dental Department of Hamad Medical Corporation in Doha, Qatar by her general dental practitioner for root canal treatment on a mandibular right second premolar. The pulp of the tooth had become irreversibly inflamed and the general practitioner initiated emergency root canal treatment. The referring dentist reported a pathologically-exposed pulp due to a carious lesion under an old amalgam restoration and a preoperative radiograph (Fig. 1) was sent with the patient. The radiograph showed a mandibular second premolar with at least two roots separating at the cervical level. The patient was asymptomatic after emergency treatment initiated by her general dental practitioner three weeks earlier. After administration of local anaesthesia and isolation with a rubber dam, the temporary filling was removed. The pulp chamber was carefully inspected with the aid of a magnifying loupe (EVK 500, Surgitel, Ann Arbor, MI, USA) and three separate root canal orifices were located, one mesially and two distally. The orifices were enlarged with Gates Glidden burs and a working length was established using an electronic apex locator (Root ZX, J Morita Inc., Japan). All root canals were thoroughly instrumented and shaped to a master apical size #35 using a profile rotary instrument (Dentsply, Maillefer, Ballaigues, Switzerland) applying the crown-down technique and copious irrigation with 5.25% sodium hypochlorite between instruments. The canals were dried with paper points and a calcium hydroxide dressing was placed (Ultracal, Optident, West Yorkshire, UK). One week later, the tooth was asymptomatic and the root canal treatment was completed, the canals were rinsed with 5.25% sodium hypochlorite solution and dried. The canals were then obutrated using size #35 master gutta-percha cones and AH plus root canal sealer (Dentsply, Maillefer, Ballaigues, Switzerland) using the cold lateral compaction technique with accessory cones (size #25). The access cavity was temporarily restored with IRM cement (Kerr, UK, Peterborough, UK) and the patient was referred to a prosthodontist. A postoperative radiograph (Fig. 2) was taken to assess the quality of obturation. The patient was recalled one year later and a radiograph was obtained (Fig. 3). Four years later the patient was referred for root canal treatment of another tooth. The patient had no complain from the previously treated lower second premolar and the follow up radiograph (Fig. 4) showed normal periapical status indicating a successful root canal treatment.
Anatomical variations, especially extra canals and roots, should always be kept in mind when treating teeth endodontically. The incidence of missed canals among retreated teeth was reported to be as high as 42%.16 Canals if left uncleaned may harbour microorganisms which have been reported to be a major cause for treatment failure.17, 18 When treating teeth with such aberrant anatomy, the pulp chamber does not appear to be aligned in its classical bucco-lingual relationship as it will show a wider mesio-distal width. The use of a magnifier is one important instrument that can aid in locating extra canals.19 Radiographs can provide to some level useful diagnostic information about the number of roots that exist but they may provide limited information about root canals as they may not be evident radiographically or may look unusual. Recently spiral computed tomography (SCT) image has been shown to be a superior diagnostic tool in providing complete detailed information about roots and root canals 20 which if implemented as a routine diagnostic tool in such cases, may decrease the chance of missing canals. In conclusion, knowledge of root canal configuration and its variations, use of magnification lens 14 and radiographs are all important aids that are needed for successful treatment.
 
|