Doug Kase
|
 ell,
readers, it’s time for some bizarre stuff. A patient presented to our office
with pain to cold stimulus and chewing pressure associated with a mandibular
right first molar. A vitality test using the electronic pulp tester and
also one using Endo-ice gave a severely hypersensitive and sustained response
indicative of acute pulpitis. Nothing strange here, but let’s move on.
Using a cusp isolator, such as a Tooth Sleuth, I
was able to elicit symptoms when pressure was placed on the lingual cusps.
Transillumination under magnification confirmed
a fracture line on the mesial and distal aspects of the tooth over the
marginal ridges. I was now dealing with cracked tooth syndrome, and I informed
the patient that the prognosis was guarded and that endodontic therapy
and full coverage would be needed. Nothing too strange here, either,
but wait!
Using the EZ-Fill™ SafeSider® technique, I performed
endodontic therapy on four canals. After I had gained access, I established
under magnification that the fracture did not involve the pulpal floor
and stopped short of the cervical area. I measured the canals, instrumented,
and dried for obturation, and that was when things started to take a turn
toward the unusual.
In the isthmus between the mesiobuccal and mesiolingual
canal (Figure 1) some debris remained; I proceeded to remove it with an
explorer only to find some trapped tissue. To my surprise, after one swipe
with the explorer this area began to bleed. Excavation with a small
round bur was then extremely productive because, lo and behold, I discovered
an extra mesial canal (Figure 2). I established measurement control
and instrumented the extra canal. I completed obturation, and the
prognosis is good (Figure 3).
Searching for the presence of extra canals—such
as a second mesiobuccal canal in a maxillary molar, a second canal or even
double-rooted mandibular canine, or even a fifth canal in a mandibular
first molar—should become second nature to the treating dentist. By taking
an angled radiograph and using magnification beyond our standard 2 times
operating loops, we should make the discovery of these extra canals much
easier. Using either 4 times wide field-magnifying loops or the endodontic
operating microscope further enhances our ability to locate these elusive
passages to the apex. Those procedures, coupled with the use of fine-tipped
ultrasonic instruments to excavate these areas, makes access possible.
Thus, in the end, it is our job to become more suspicious of these teeth
and look for the unusual. My motto is “If you see three, look for
four. If you see four, look for five. If you see five, it’s
probably a third molar!”
January-February 2002
 |
FIGURE 1: Debris in the isthmus
between the mesiobuccal and mesiolingual canal.
FIGURE 2: Note the five instruments.
FIGURE 3: Completed obturation.
|
