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From: Jörg Schröder
Sent: Friday, December 16, 2005 10:37 PM
Subject: [roots] Upper First Bicuspid with one canal
This patient came in for removing a fractured instrument. This happend
during the retreatment. She reported having pain on this tooth since
5 months. She was on ibuprofen 600 mg since 5 month!!
Removing of the fragment has been very simple. I than expected to find
two canals. But even after almost 1 hour, I could not find a second one.
Since using a scope I am always kind of scared to miss anatomy. So I
told the patient I will have a look for the missing one next time.
But even then I could not locate any orifice.I was afraid of perfing
lateral and so I cleaned and obturated only one canal.
Masterpoint did not look centered. At the end I was disapointed twice:
First I had to finish with obturating only one canal and was not sure
if I had missed another one and second I ruined the build-up because
the composite set before I could place the post. At the end I had lots
of voids inside the composite.
But: Patient is free of pain. So that's not a beauty, but I hope it
will heal. Does anybody know how often upper bicuspids
with a single canal occure?. Or is there still a untreated canal?
Comments and help are very welcome. Jörg Schröder - Berlin, Germany
Hi Jörg, Max premolars do have sometimes one canal, I attached a slide
with some figures, this is from a publication of Vertucci
(1974 and 1979). Some more details from the Vertucci paper on first
max premolars, the sample consisted of 400 premolars with 788 canals:
The root canal configuration of the first max premolars can be quite
complex, with a lot of accessory canals (50%) and anastomoses (35%).
The location of the foramen is lateral in 90% of the cases, and there
is an apical delta present in 3% of the cases.
Your documentation is excellent. I can understand your frustration,
you don't want to give up to easily, but at the same time you run the
risk that you remove sound tooth structure, and weaken the tooth
significantly. In your case the remaining dentinal wall thickness is
significantly reduced, especially at the mesial side. It is a difficult
decision process, decide when to stop. I still have these decision
problems once in a while, you never stop learning - Marga
Marga, thank you very much for -the slide. It reduces my "pain"
a little bit - Jörg
Don´t be afraid Jörg, the literature supports your one canal upper
bicuspid ( Hess-19,5% and De Deus-8,3%) and when that happen the canal
follows the tooth anatomy as in the case you did. As a matter of fact
you did a great case - Sergio.
Jorg, Beautiful documentation. I doubt you could have missed a second
canal, had one been present. I always take a sharply angled mesial
shift with my first file in place if I have any doubts about number
or location of any other canals. It works beautifully for one and two
canal cases. Three canals are a little trickier - DougR
Just to reduce your "pain". The image shows the pulpar anatomy of 108
upper first bicuspids obtained by diafanization (De Deus). Greetings
from Brazil - Sergio
What a fabulous photo. I'm definitely keeping that one - Gary
Hi Marga, when I saw your e-mail, I've remembered my case which
I didn't post...
Greetings - Marek Korzan
I forgot to attach a build-up ...
DT Light Posts cemented on Build-it ,(Bond 1).
Wow Marek, What a nice case, and your pics are outstanding!
Keep them coming! - Marga
Marek , Just beautiful. Those 1st pm can be tricky…..
Congratulations - Sergio
Marek, beautifully done and the photos are exceptional.........
as I love to say....
CLAP CLAP CLAP (PS I am standing at present!) Grin - Glenn
Hi Marek ! Congratulations for your beautiful case !!! And also
I love the very good quality of your pics !!! - Roberto