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.

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!

Why do I need my root canal retreated? - Answer 1

Pre retreatment picture - notice the white filling on the right

Post retreatment image - see the additional canal treated on the right

There are many reasons why your root canal needs to be redone and with this post I will address one reason.  Probably the most common reason I encounter is an extra missed canal.  Before I begin I want to make it very clear that these are not always easy to find or treat.  Sometimes I know there is one there and I drill down a root trying to treat the canal.  Eventually I have to weigh the risks of drilling down a root with the risks of leaving the canal untreated.  Luckily root canals are very successful and most of the time they work well even if we can't get down the root, but I love to find and treat these extra canals.  It is challenging and fun. 
Now onto the images above.  This is a radiograph (or x-ray) of a tooth with a root canal.  The first image was how it presented.  The patient had an abscess or pimple on the gums next to the tooth.  This is simply a path for infection to drain from the root tip out of the bone.  If you look at the first image you can see 3 canals that were treated.  The canal on the right is inside a root we call the MB root.  MB stands for mesial buccal or toward the midline and toward the cheek because this root is oriented toward the midline of the teeth and toward the cheek relative to the entire tooth.  This is the root that tends to have more than one canal.  We call the canals MB1 and MB2 because they are both located in the MB root.  In the second image you can see after we retreated the tooth and located the second canal or MB2.  The pimple healed and the tooth has felt better since cleaning the bacteria out of the second MB canal.
So does your tooth have an "extra" canal.  It is hard to say because there is so much variability with teeth.  Some upper molars have one canal, some two, most have three or four and occasionally they can have more than four.  So I always look for four and expect to find four or more.   If you have a question concerning your upper molar or root canal visit our website www.baumanendo.com or call our office at 801-793-8822 for more information.