Vertucci’s Type V Canal Configuration in Lower Premolar

An Intricate Root Canal Procedure. Case Study Number 041340

This patient regular dentist refused to put a post and a crown on this lower right second mandibular premolar judging this previous root canal treatment a bit short (more than 2mm from the apex) and convinced her patient for a root canal retreatment.

After retreatment which implied a large ledge bypass, careful examination under the high magnification of a dental operating microscope (DOM) revealed a lingual canal which separates from the main canal at nearly a right angle.

This was a Vertucci type V canal configuration which required widening of access in a lingual direction in order to achieve straight-line access to the lingual canal.

A Vertucci type V pulp space configuration can be described as follow:

• One canal leaves the pulp chamber and divides short of the apex into two separate distinct canals with distinct foramina (1-2).
• In the apical third of the root, each part of the split as been individually cleaned, shaped and filled with gutta Percha and Pulp Canal Sealer.
• Missing that second canal would have led to a treatment failure.
• The referring dentist just save his patient the biological cost of loosing that tooth plus the financial cost of replacing it by an implant supported crown.

  (Cost roughly estimated to 4500$ including one casted post, one crown on a tooth with a very bad prognosis then an extraction of this very same tooth plus one implant and one implant supported crown).