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  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
To: ROOTS
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
this).

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 occurence, however. 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

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