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 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!

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.



More examples of failing root canals because of missed canals

This is an addition to the last post.  Once again, it is easy to put successful images up but sometimes it is not possible to find additional canals because they are so small and often calcified.  I will address calcification in another post.  I am adding this post to show that there are other teeth that can have missed canals.  Upper first molars are probably the ones I see the most but almost any tooth can have an unusual anatomy. 

This one is similar to the previous picture. The same root on the right called MB2 has an additional canal.  This is an upper first molar.

This one is a bottom tooth.  The really white part you see is the metal foundation of the crown.  You can see the root on the left side in the second image has an additional canal treated which solved the pain problem for this patient.

This last one is tooth #19 and it is a little less common.  In the first image you see three canals treated.  Most often there are 3 or 4 canals for this tooth.  However, when there are 4 there are usually 2 in the mesial or front root (the one toward the midline of the mouth) and 2 is the distal or back root.  As you can see in the second film this one has 3 canals in the mesial roots (left root as you look at the picture).  This canal is called the middle mesial canal (because it is between the other mesial canals).  This is the type of canal that can lead to a tooth with 5 or 6 canals.  This is not very common but can often be the cause for a root canal that is not working. 

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.