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8 canal molar: confluent systems - Courtesy ROOTS

The opinions and photographs within this web page are not ours. Authors have been
credited for the individual posts where they are -
From: Terry Pannkuk
Sent: Saturday, July 01, 2006 6:31 AM
Subject: [roots] The "8' Canal Molar finished today

This was the case I presented as unfinished at the Summit and I finished it today.
It really did have 8 canals, an MB1, MB2, MB3, DB1, DB2, DB3, P1, and P2.  Of course
there were some confluent systems (MB1-MB2, DB1-DB2-DB3, and P1-P2), BUT it sure
seemed important to regard them as 8 canals and I fitted 8 cones as shown in the pics.
The DB root can clearly be shown to have 3 converging systems.  The MB1-MB2 didn’t
really look like separate systems at the end but on further inspection you can see
a midroot accessory canal that probably wouldn’t have been addressed if the MB2
wasn’t cleaned shaped and flared into the MB1. The Palatal systems were connected
by a wide confluent fin with apical branching.

Maybe an insurance company would only count this as a 4 canal molar.  Maybe you will
count it as a 6-canal molar, but in order to treat it properly and give it my best
effort, I had to visualize it as an 8-canal molar and treat it as such fitting 8 cones.
- Terry

Your cases and lecture are inspirational. I love'em ! Keep them coming - Thomas Awesome, Terry! How long did it take you (in total) to finish the case? You just remainded me that these are not only "canals"... thanks. - Dmitri Thanks Dimitri, It took me 6 ˝ hours. Without troughing and exploration of the MB3 and extra DB’s it could have been treated in 1 ˝ hours. I spent much of the time figuring out the DB root anatomy - Terry Amazing! Was looking forward to the finished case after seeing the first part in Amsterdam. Really Appreciate the teaching in Amsterdam - siju Hi terry , sometimes i ve got the problem with masterpoints in dry canals, if the tug back is very stiff. i ve less problems with prewetting them or using the masterpoints as last irrigation transporters. as i could see in your pictures the canals arent absolute dry . do you fit masterpoints normally in absolut dry canals? - Holger Dennhardt No, I fit the cones in wet canals (NaOCl) My final rinse before drying to pack is Chlorhexidine. - Terry Hi Terry, that's a great one! - Winfried I think you should submit this to the guiness book of world records. I've never found more than 5. - gary Amazing stuff was a great experience meeting you in Amsterdam and you were considerate enough to spare some time to answer some of my queries.... Thanks for sharing and teaching................Sachin Superb case. certainly archivable. thanks for sharing it. Is there a pulp stone in the chamber Dr. Terry?? - Ananya

Protaper flaring
6 yr old Empress
Cvek pulpotomy
Middle mesial
Endo misdiagnosis
MTA retrofill
Resin core
BW importance
Bicuspid tooth

Necrotic #8 treatment
Finding MB2 / MB3
Deep in a canal
Broken file retrieval
Molar cases
Pushed over apex
MB2 and palatal canal
Long lower third
Veneer cases
CT Implant surgury

Weird Anatomy
Apical trifurcation
Canal and Ultrasonics
Cotton stuffed chamber
Pulp floor sandblasting
Silver point removal
Difficult acute curve
Marked swelling
5 canaled premolar

Sealer overextension
Complex anatomy
Secondary caries
Zygomatic arch
Confluent mesials
LL 1st molar (#19)
Shaping vs Cleaning
First bicuspid
In Vivo mesial view
Inaccesible canals

Premolar 45
Ortho and implant
Lateral incisor
Churning irrigant
Cold lateral
Tipped to lingual
Acute pulpitis images

Middle distal canal
Silver point
Crown preparation
Epiphany healing
Weird anatomy
Dual Xenon
Looking for MB2
Upper molar resorption
Acute apical abcess
Finding MB2

Gingival inflammation
Irreversible pulpitis
AG BU ortho band
TF Files
using TF files
Broken bur
Warm technique
Restorative prognosis
Tooth # 20 and #30

Apical third
3 canal premolar
Severe curvature
Interesting anatomy
Chamber floor
Zirconia crown
Dycal matrix
Cracked tooth
Tooth structure loss
Multiplanar curves