Lower molar with six canals
The opinions and photographs within this web page are not ours.
Authors have been credited |
for the individual posts where they are.
Photos: Courtesy of Jörg Schröder - www.rxroots.com
From: Jörg Schröder
Sent: Wednesday, July 27, 2005 4:19 AM
Subject: [roots] Lower Molar with 6 canals?
Treated this one yesterday. Patient asked if scope is really
necessary in this case. ( her insurance will not pay for
As I started it looked like a small isthmus between each the
distal and the mesial canals. I started joking: " If there
will be only those four, we will finish this tooth today".
Tooth seems to be a funny one and he released No. 5 for me
(MM)!!! (Arrgggh). After the wire film something forced me
to use a ISO# 6 handfile and surprise, surprise it went down
22 mm between the distal canals. ( I heared somekind of laughing
out of the rubberdam and a voice said: Here's another
one for you!) There seemed to be no merging when I put
handfiles in all three distal canals. I than finished the distal
ones and rescheduled the patient for the mesial ones.
(pictures will be posted soon)
To me it seems that in teeth with 5 more canals there are
only very narrow isthmus between the main canals with a
wider part where I am creating a (irrigation-)canal.
Any opinions if this is true? - Jörg Schröder, Berlin, Germany
Good job Jorg, Nice photography as well. A good "starter file"
for these isthmus canals is a 21mm #8 or #10 C file.
They are a bit stiffer and will avoid buckling a little better.
It doesn't matter. Did you get the tooth cleaned out better
than if you had not placed an instrument in there? If you
think about it for just a moment on a tissue and microbiological
level, relate that to the size of an instrument vs the
size of bugs, the answer is obvious.
I posted my protocol on management of these isthmus or middle
canals, earlier, but here it is for you again:
That's great. Here is how I managed these cases, because the
dentin in this area is quite thin, and I don't recall a
post on this subject matter. The invagination in the blue
area of Ben's post is often WORSE than is drawn. You
restorative guys, look at those teeth when you take them out,
then ask yourself how bright it is to take a #2 peezo to
6mm from the end...
1) Locate and negotiate, and with a #10 or 15 establish a length.
2) Now that I have a V-Taper #10/.06, take that to length...
and a little bit.
3) suction out the MB and/or ML backdrawing on your NaOCl syringe.
If the MM drains at this point, and the root appears thin, you
may want to terminate the preparation. If they join this easily,
you will fill it on the squirt. This is a relatively rare
4) Brand new #2 S29/.06 to length and a bit. Repeat step 3. If it
drains, you are done. If not, check patency on all canals and
repeat step 3. If still not, go up to #3 and repeat the draining
test w/ patency check. If still not, go up to #4 and repeat
draining test w/ patency check.
If at this point, the MM does not drain, it is prepped out large
enough (#4S29/.06 = ~20/.06) to fit a cone and truly
treat as a separate canal, regardless of whether it is or not.
Never go past a #4 unless you have a convincing reason
to do so. Retreatment is much easier than retreatment + a strip
perf repair... :-)
You will notice in essentially all of my MM posts that the middle
canal is markedly smaller...It almost always joins
the MB or ML.
In a maxillary molar with three MB's, the DB2 and any other
"fin/isthmus/whatever" canals I will do the same. Just
finished a C-shaped lower second molar. Took three visits,
but all the canals drain together now, which they should,
since it is one, big canal anyway. - John A Khademy
John,I agree totally. I changed all my handfiles ISO# 6-12,5
into C-files.- Jörg
Miltex just came out with a high 5 file, similar to the flex-r
but stiffer ss, very similar to the c files. I have
both and they both work well. - gary
Hey Jorg.......what a beautiful result so far.......
.CLAP CLAP CLAP.......
The mesial sure looks intesting as well. Please show us the
finished case and your photos and layout in powerpoint are
very well done. Thanks for taking the time to do this. - Glenn
Jörg, Nicely handled and beautiful pics. If you want to decrease
the size of your attachment, save the slides as jpeg. If you post
the slides, you only have to scroll down after reading the text.
No need to go to PP. Just like this. - Marga
Very nice indeed Jorg...........................do you feel that
the distance between the two canals gives any indication of a
third canal in the distal? I have downpacked a lower molar with
Ca(OH)2 and the two distals have quite a distance between them
and are divergent. Should I trough between the two?? - Sachin
Sachin, I think I was able to look for the middle mesial/ middle
distal because of the scope. It gives me a much better
view than the loupes. I don't expect a addititional anatomy
because of the distance (see how near the distal canals
are compared to the mesials?) Out of curiosity I sometimes
change back to the loupes after identifying the orificies
with the scope. In 80 % of the cases I would not have been
able to see them, or an isthmus or a fin. Maybe it is
possible to find more additional canals without having a scope
with the Microopener Handfile ( Dentsply Maileffer) It
is much stiffer than a C-File, comes in ISO 10 and 0.4 and
0.6 taper. It got handle like a normal dental explorer. I
would feel better doing this than troughing with US or burrs
without a scope. Regards - Jörg
Your comments please