Case 70 Three Definitive Mesial Canals

Pre-Op Xray #30

Post-Op Xray #30 (polarized xray)

Comment: Need I say anything?
Usually a "3rd canal" goes into either the mesial lingual or mesial buccal canals on a lower molar.
Occasionally, there are 3 separate canal systems in the mesial root of lower molars.
If you have properly cleaned the mesial lingual and mesial buccal canals and they are dry,
but there is exudate between the two, it usually means a 3rd canal is present.

Case 66 Good Result

Pre-Op Xray #31

                                                                               Post-Op Xray #31

Post-Op Xray #31 (8 months)


Comment: What you want to see, post operatively, in a necrotic tooth with periapical lesions.

Case 57 Mesial Buccal Root Amputation

Pre Op # 14

Fractured mesial buccal root. Patient had option to extract with implant or mesial buccal root amputation.

Final Film #14

Mesial buccal root removed. Solid bone around distal buccal and palatal roots.

Post Op 7 Months #14

Healing has occurred with bone fill in in the area of the mesial buccal root. Probing is within normal limits.

Post Op 13 Months #14

13 Months with crown. Pt extremely happy. No periodontal problems.

Comment: Some patients just do not want teeth removed. If within reason there are alternative treatments for fractured teeth, for instance, if a fractured root can be removed with no undue periodontal problems and the patient understands the home care situation, then amputation is a viable option. The patient must understand that a new crown has to be placed.

Case 56 Locate ALL Canals

Pre Op #30

Symptomatic tooth, #30 that had been referred where all the canals had not been found. In particular, the mesial buccal canal had never been negotiated.

Pre Op #30

Additional Pre Op film

Final Film #30

Mesial buccal found and there were two canals in the distal.

Final Film #30

Additional final film.

Comment: When dealing with lower molars remember there are usually at least three canals. Two canals maybe found occasionally in second and third molars.

Case 55 Bone Loss in Furcation Usually Indicates Fracture, USUALLY

Pre Op #30
Root canal with furcation bone loss but not probeable.

Final Film #30

Retreatment completed, no fractures noted in access opening.

Post Op 6 Years #30
Bone completely fills furcation.

Comment: A dirty canal system in a tooth with a root canal is not recognizable on an x-ray. Cleaning the canal system is the only way to ensure that the canals are clean and sterlie. An access opening also can reveal the presence of a fracture many times.

Case 54 Retreatment Very Common, Mesial Root Not Cleaned

Pre Op #19
Symptomatic with swelling over mesial buccal root.

Final Film #19

At First appointment mesial canals cleaned thoroughly, at second appointment all canals were obturated down to radio graphic apex.

Post Op  21 Months #19

Symptoms gone and apex area of mesial root completely filled in with bone.

Comment: Mesial canals of lower molars are very commonly not cleaned well enough to the radio graphic apex. When retreatment done the canals in the mesial root are cleaned thoroughly down to the radio graphic apex.