Many Roots and Canals - A Clinical Case
MANY ROOT AND CANALS - A CLINICAL CASE
A 62 year old, female patient, undergoing major restorative work, was
referred to our office for endodontic therapy on tooth no. 17. This tooth was
the terminal abutment for a 95-unit(!) bridge. Removal of the old restoration
revealed a pulp exposure, and the referring dentist performed a pulpotomy on
the tooth. The patient was comfortable.
After removal of the temporary bridge, a small scar line was noted on the
occlusal gingiva. This was a result of some prior periodontal surgery. Pocket
depth was very minimal. There was no percussion sensitivity. The clinical
outline of the tooth was different from what would be expected of this tooth.
A working radiograph (shown below) taken by the prosthodontist accompanied
the patient. It demonstrated what appeared to be a two-rooted, calcified tooth.
It was also observed that the maxillary sinus was very close to the crestal
bone, as a result of extractions from many years ago.
The patient was informed that her tooth had an unusual root structure and
formation, which may possibly complicate the endodontic therapy. This tooth was
crucial for her bridge, however, and she wanted to try and keep it.
After adequate anesthesia was attained , a rubber dam was placed around
tooth no. 17. The temporary filling was removed, and access was gained. The
floor of her pulp chamber was shaped like a butterfly. Five main canals were
located here. These canals were quite calcified, due to the old, deep
restoration. This made cleaning & shaping very difficult. Furthermore, two
canals had a horizontal communication, and created further problems: As one
canal was cleansed, dentinal debris entered the other canal.
After cleaning and shaping of the entire root-canal system was accomplished,
gutta-percha cones were fitted and a radiograph taken. The root-canal system
was obturated using Kerr sealer with Vertical Condensation (Warm Gutta-Percha).
The final radiograph demonstrates some of the complexities that this tooth
exhibited. It was interesting!