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The opinions within this web page are not ours. Authors have been credited
for the individual posts where they are. - www.rxroots.com Images courtesy: Jörg Schröder , Marga, Marek Korzan

From: Jörg Schröder
To: ROOTS
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!! 

Click here for the Slide Show - Courtesy of Jörg Schröder
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
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