Microendodontic. Case Study Number 493847
Key words: Root canal anatomy, anatomical variation of teeth, radix entomolaris
The anatomy of the root canal system directly affects the success of the root canal treatment. This postpresents a case report of a mandibular second molar with five canals and five different apical foramina. Theintraoral clinical examination revealed a tooth affected with deciduous restoration, and a sinus tract. On radiographic examination, the distal root larger than average width did let us suspect the presence of four separate roots. Other radiographic findings: Alveolar bone with circumscribed radiolucent apical lesion. The diagnosis was a pulpal necrosis and a chronic suppurative periradicular periodontitis. Etiology: marginal leakage, caries.
First appointment: gaining coronal-radicular access to the 5 canals, locating entries, shaping and cleaning apical root canal branches inserting intracanal medication for 8 days. Third X ray image shows the fift short canal extending from pulp chamber to the interradicular space.
Second appointment: intracanal medication retrieval, copious CHX 2% irrigation, drying canals and permanent root canal obturation with Pulp Canal Sealer and gutta percha (lateral and vertical condensation).
In that specific case, the endodontist microscope insured a better prognosis for this patient because it has been most helpful when striving to find the root canal split in distal root and because it prevented us from omitting the fifth root canal.
Even when complete root canaltreatment has been carried out the patient still has to be periodically evaluated for prognosis.