Kase of the Month - Never Assume

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There are time when assumptions just don't hold water. We all sometimes assume that the anatomy of many roots are written in stone. Maxillary anterior teeth should have only one canal and any irregularities seen on a radiograph are attributed to invaginations in root morphology or artifact, because how could a central, lateral or canine have 2 canals or for that matter 2 roots. We all know that the appearance of an MB2 canal in a maxillary first molar happens 65% of the time. This is not "fake news"! Lower first premolars can easily present with 2 canals. Maxillary second molars can have an MB2 as well. Thus it becomes imperative that we don't accept root or canal morphology as "knee jerk or boiler plate." Angled PA radiographs from both the distal and mesial are helpful. A CBCT scan would be imperative if in doubt. Wouldn't it be nice to know the actual number of canals in a tooth before needless excavation is started and tooth structure is undermined rendering the root more susceptible to fracture. If it is present, then using a scope and conservative excavation is indicated. Don't take it for granted!

Here is an example of a failed case due to a missed lingual canal in a supposedly one canal lateral incisor. The original fill looked good however the angled radiograph was suspicious and ultimately the case developed a PAR.

Figure 1

The case was CT scanned and a lingual canal was identified. I removed the post and under the endodontic scope I found the unfilled canal and took measurement.

Figure 2

The canal was instrumented and ultimately filled using our E-Z Fill technique.

Figure 3

The case was re-posted and sent back to the DDS for final restorative.

Figure 4

Happy ending and a good save.

See you next case!!!