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.