Lower molar with an extra mesial canal!

Here is one more example of a tooth that has an unusual number of canals.  The mesial roots (the ones toward the front of the mouth) usually have two canals but this one has a third in the middle.  This canal is not obvious to find and is often missed when it is present. 

 

Tooth #30 has previously been accessed and the patient continued to have severe pain.

Here are the MB and ML canals which were already instrumented

Here is a file locating the middle mesial canal.  When present this canal usually joins with the adjacent canals but in this case it is an independent canal.

 

The three canals when they have been cleaned completely.

Final film that shows the 3 independent canals

Three independent canals.

 

Unusual anatomy in one of the reasons people can continue to have pain with a tooth or problems after having had a previous root canal.  An endodontist using a microscope can often find these difficult canals.  You can find more information about Bauman Endodontics at www.baumanendo.com

 

How many canals are normal in a pre-moalr?

The most common questions I continue to be asked by patients are: Why do I need to have my root canal redone? Why didn't they find all the canals the first time? Why do you think you can find it if my dentist couldn't?

 

I continue to answer that additional canals are probably the most common reason I retreat teeth.  The reason is that "root canals" or root canal therapy is difficult and all teeth are not created the same.  Each tooth and person is different.  It is what makes my job interesting and enjoyable.  Here is another case of a missed canal in a pre-molar. You can again see how a microscope helps us see these canals when they branch down the root.

 

 

A patient presented with an infection associated with tooth #5.  Our upper pre-molars usually have one or two canals.  Occasionally they can have more.  When they do their orientation is similar to an upper molar.  In this radiograph the missing canal would be called the distal buccal canal

 

 

Here is the same tooth after the additional canal has been treated.  Although smaller it has a similar appearance to the root canal on tooth #3.

 

 

Here is the appearance of the canal with the previous filling material still in place.

 

 

Once the filling material is removed then we can see that this canal is slightly off center in the tooth. 

 

 

Here are the two buccal canals after cleaning them out.  Even after cleaning them it would be difficult to see them without the use of a microscope.

 

I have previously posted a case of an upper molar with extra canals and thought I would add a pre-molar.  We can see this in lower molars as well and I will add a lower molar with an extra mesial canal in my next post.

Little Shop of Horrors clip!

http://youtu.be/6K2f2d81g6I

How many canals are normal?

I was reading a post on www.theendoblog.com (this blog is well done) and they were discussing missed canals.  If you have read previous posts you know that I retreat many teeth with missed canals and feel that we should make every effort to find them the first time.  This then leads to the question of how many canals are normally in a given tooth? 
This is a tough question because it is variable.  Also canals can join so it may have 4 canals in the chamber but two may join and exit at the same place.  Upper first molars usually have 4 but sometimes they only have 3.  Below I will share a case with 5 canals.  Upper pre-molars usually have two but can have one or even three.  When we treat teeth I feel it is best to assume there are more canals and take the time to look for them. It is very hard to find these canals without the help of the operating microscope, but even with the microscope we will never find them if we don't look.  Here is a case of an upper molar that has more than the "usual number" of canals.  This one has 5 canals as I mentioned above and none of them join.  I will add more posts later with other interesting teeth with more than the "normal" number of canals.

 This is tooth #14 before treatment

 

 This is the area of the tooth where we find the mesial buccal canals.  This root usually has two canals and the second canal is the one that is usually missed.  Here a file is going into the second canal - you can see how small it is even under the microscope

 

 Now we have started to treat the first two canals and we find another one between them - here the file is going into a third canal in this root.  People often ask me why a canal wasn't found the first time.  I answer that it is not easy to find them as seen in this picture.

 

 

Here are all three mesial canals after we have cleaned and shaped them.

 

Here is the final radiograph that shows all three extend down to the end.  two are hard to detect and you can only see they are separate at the end.

How does a microsope help with a root canal?

Has your dentist ever told you that he or she can't do this root canal and sent you to an endodontist?  Often they will say...they have a microscope which will help them find the canals!  This is true!  The microscope allows us to see deep inside the tooth and find little branches or canals that are hard to find.  Here is a demonstration of the 6 different magnifications that I work with.

 

Above is a dollar image taken with a camera and no magnification.  Imagine that you are looking into a tooth trying to find canals the size of Washington's pupil.

 

 

 

Above is the dollar image taken with the lowest magnification on the microscope.  Remember to look at Washington's eye

 

 

 

 

 

The above magnification is where I do most of my work and then go to higher magnification in specific instances.

 

 

 

Here is the highest magnification.  As you can see it is much easier to find a canal the size of Washington's pupil at a higher magnification.

 

 

The microscope has changed endodontics and allows us to find canals that we couldn't have found before.  I can't imagine working without one!



Don't put off your root canal!

Kid History: "Healthy Food"

MouthHealthy.org is Now Live

This has some really useful information on it, try it out!

MouthHealthy.org, the ADA’s new website for consumers, has information you need to take better care of your mouth today so it will take care of you for life.

Visit your life stage and find healthy habits, top concerns, nutrition and fact or fiction.

The Bauman Family

Funny Dentist Cartoon

We found this new post by the ADA helpful and interesting

 

 SHOULD I TAKE ANTIBIOTICS BEFORE MY DENTAL PROCEDURE?

 

You have an orthopedic implant (joint replacement, metal plates or rods, etc.) from a previous orthopaedic surgery.

• A potential complication of these implants is bacterial infection, which occurs in approximately 1-3% of patients. These infections require more surgery as well as antibiotic usage for an extended period of time. Most infections occur around the time of the procedure (within one year), but some have occurred much later.

• In theory, late implant infections are caused by the spread of the bacteria from the blood stream to the implant. Unfortunately, there is no clear scientific evidence to support this theory. We know that many patients with orthopedic implants frequently have bacteria in their blood that does not spread to their implants.

Dental procedures have long been considered a potential cause of implant infections even after the initial orthopedic postoperative period. This is because dental procedures can introduce bacteria from the mouth into the bloodstream. However, this fact should be considered in the context that eating and performing oral hygiene at home may also introduce oral bacteria into the blood.

• Traditionally, antibiotics have been provided prior to dental procedures in patients with orthopaedic implants to minimize the bacteria that get into the blood.

• Best evidence, however, does not show that antibiotics provided before oral care help prevent infections of orthopedic implants.

• The routine use of antibiotics in this manner has potential side-effects such as increased bacterial resistance, allergic reactions, diarrhea, and may even cause death.

Patients who have compromised immune systems might be at greater risk for implant infections;

• Diabetes, rheumatoid arthritis, cancer, chemotherapy, chronic steroid use are examples suggesting immunosuppression. Please discuss your potential for immunosuppression with your physician or dentist.

• Patients who are immune-compromised might wish to consider antibiotics before dental procedures because of their greater risk for infection.

• Decisions with regard to antibiotic premedication should be made by patients, dentists and physicians in a context of open communication and informed consent.