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Many Roots 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.

pre-op x-ray working x-ray working x-ray post-op x-ray

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! © 1999 - 2002, Todos os direitos reservados.
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