3D Clinical Evaluation of Unusual Anatomy of A Maxillary Second Molar: A Case Report

Abstract

Aim To present the combined use of CBCT images and new endodontic software to identify and then facilitate the location and treatment of a canal in an unusually placed second mesio-buccal root of a maxillary left second molar. Summary A 45-year-old female was referred for root canal treatment on her maxillary left second molar tooth (tooth 27). Due to superimposition of the third molar and the position of the tooth that made conventional radiographs unhelpful, a pre-operative limited FOV, Low-Dose Technology™ CBCT image was taken with an OP-300 Maxio™ device (Instrumentarium, Helsinki, Finland). The CBCT images were then imported and analyzed using 3D Endo™ Software (Dentsply Sirona, Wels bei Salzburg, Austria). Within the software, the canal orifices and foramina were located and identified on the display, which allowed the software to automatically reveal and measure the pathway of each canal, which was traced and viewed in both frontal and mesial perspectives. The images revealed the presence of a separate second mesiobuccal root that contained one canal. Root canal treatment was then performed using the information derived from the software. The orifice of the canal in the second MB root was located in an unusual position: 5.99 mm palatally to the main MB canal and 7.57 mm medially from the palatal canal. An immediate post-operative limited FOV, low-dose CBCT was taken to assess the quality of the root filling. After one year the tooth was asymptomatic and radiographic examination revealed no sign of periapical pathosis.

Medición del ángulo vestíbulo-lingual en conductos mesiales de primeros molares inferiores utilizando tomografía de haz cónico.

“…En la actualidad, con la ayuda de microscopio endodóntico, la tomografía de haz cónico (CBCT, por sus siglas en inglés) y diversos softwares como el 3D Endo TM (Dentsply/Sirona USA) podemos identificar y visualizar la trayectoria de los conductos en estos dientes, así como su localización respecto a diversas estructuras anatómicas antes y durante el abordaje endodóntico. 2 Schneider fue el primero en establecer un método seguro y de confianza para poder determinar ese grado de curvatura a partir de vistas radiográficas clínicas, pero no investigó desde la vista proximal. 3…”

Determinación de la Longitud de Trabajo Mediante Localizador Electrónico de Foramen Apical y CBCT a Través del Software 3D Endo de Dentsply Sirona: Estudio Comparativo in vitro

“…Dentsply Sirona desarrolló en el 2016 el 3D Endo Software (Dentsply Sirona, Salzburg, Austria) para la planificación de tratamientos específicos de procedimientos endodónticos (Di Nardo et al, 2018), teniendo como uno de sus objetivos eliminar la desventaja de la determinación de LT de forma manual. Se diferencia del resto de los software en que proporciona ayuda para la visualización, el diagnóstico y la planificación de tratamientos endodónticos y retratamientos mediante imágenes tridimensionales de forma semiautomática, por lo que tiene el potencial de minimizar los errores subjetivos relacionados con el operador.…”

Unusual anatomy of permanent maxillary and mandibular molars: Case reports

“…It is known that there are numerous variations in the root and root canal anatomy and morphology of multi-rooted teeth, especially molars [1]. Knowing possible anatomical and morphological variations is extremely important for successful endodontic therapy, but also for the extraction of such teeth [2].…”

“…Anatomical and morphological variations and rare abnormalities of roots and root canal systems had been shown in previous studies [1,2,3]. The literature shows that maxillary molars can present from the simplest to the extensively complicated root and root canal anatomy and morphology [8][9][10][11][12][13][14].…”