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Mandibular molar : three distinct distals
The opinions within this web page are not ours. Authors have been credited for the individual posts where they are. Photos courtesy Rob Kaufmann - ROOTS From: Rob Kaufmann To: ROOTS Sent: Friday, February 03, 2006 12:09 AM Subject: [roots] Mandibular molar with 3 Distals 2 I've been getting a lot of weird anatomy lately. (Not to mention cases sent to me AFTER they have been started) Grrrrrrr. Here's a mandibular left first molar with a bit of "history". Prior emergency access by someone other than his own regular dentist. Lingual furca now probable. Not a good sign. I suspect a possible access perf. Open tooth. Yup, there it is. He missed on of the M canals. Small hole into the furca. I finish cleaning and shaping two mesial and two distal and plan to repair the furca perf with MTA once I'm done. I've finished fitting the M cones and am working on fitting the distals when I take a closer look with the scope in on the DB. Tucked under the DB cusp is a third separate orifice. Stop. reclean the distals again and find that it is a totally separate canal and POE. Cone fits confirm that they don't join at the apex. I never would have seen that 3rd distal canal without a scope - that's for SURE. Warm vertical to pack. MTA furca perf repair. Orifices bonded with Perma Flo purple. It'll be interesting to se if we get enough healing in the furca area to merit final casting. I'm bringing him back in 3 months and telling the Dentist to place a core in there and wait for my recall evaluation. Enclosed images - RobRob...I've repaired so many Furca's with MTA...it will reproducably repair as long as you don't have terrible perio. So I'll bet the furca heals... - Joey D Joey do you have a protocol for mta repair,i.e.before or after the rct or with or without prior calcium hydroxide do you think there is a definite protocol or is a good sodium hypochlorite rinse enough - solly Solly, With furca repairs...the best time to patch'm is sooner...but I don't have a specific protocol.... Let me give an example...let's say I open into a tooth, pus or junk is oozing from the furcation...I have found those to be poor candidates for MTA repair right then...sometimes the MTA doesn't set if repaired at that time...so I'll try irrigating with sterilox and then place CaOH into the area and typically in a week have them back, they are much better off and no longer oozing and now I consider them biologically ready to patch the perf... Some perfs...say Strip perfs really can't be repaired until after the prep and obturation of the portion apical to the site.... Here's my final "protocol" just priot to placing the MTA.... 1. Rinse with NaOCl, let stand for a minute 2. Rinse with Citric Acid...let sit for 2 minutes. 3. Rinse with NaOCl, let stand for 2 minutes..... Now it's time to place the MTA - Joey D, "Does this help" I have started using citric acid for smear layer removal,do you dry the naocl before or merely inject into canals,if so does this not dilute to much I want to place the citric acid into dried tooth but have been worried about it being a bit too aggressive - solly Nice rob. I think that qualifies as a five banger, albeit a reverse one. - gary Nice work Rob! I don't think I've ever had 3 distinct distal canals. Nutsy anatomy there. I'm sure you earned some brownie points with your referring doc over that save. - Mark Cool. Not sure I've ever seen three distinct distals - Kendel Rob, knowing that they are of no consequence in a great case, why the tiny voids on the inside of the knees of the mesial roots? I get those occasionally with large taper single cones and have to go back with Pac Mac to remove them. Guy
