Bilateral mandibular canines with two roots and two separate canals: case report

The mandibular canine is usually considered a single-rooted tooth with a single root canal. However, two canals and more rarely two roots may also occur. This paper reports the case of a patient with bilateral mandibular canines with two roots and two root canals. The initial periapical radiographs of the mandibular right and left canines for endodontic treatment revealed the presence of two roots in each tooth. After coronal opening, the cervical third was prepared with a SX file of the ProTaper® system and root canal length was confirmed using Root ZX electronic apex locator. Root canal preparation was completed with the series of ProTaper® instruments and the root canal was filled with gutta-percha and an epoxy resin-based endodontic sealer according to Tagger's hybrid technique. The final radiographs showed two well-obturated canals ending at the electronically located apexes. The 6-month posttreatment follow-up showed apparent clinical and radiographic success. Clinicians should always consider the presence of anatomical variations in the teeth during endodontic treatments. Despite the low prevalence, variations may occur in the number of roots and root canals of mandibular canines, as demonstrated in this case report.O canino inferior é tido como um dente unirradiculado e com apenas um canal. Todavia, pode ocorrer o aparecimento de dois canais e, mais raramente, duas raízes. Este artigo apresenta o caso clínico de uma paciente com ambos os caninos inferiores apresentando duas raízes e dois canais radiculares. A radiografia inicial periapical dos caninos mandibulares inferiores direito e esquerdo para tratamento endodôntico revelou a presença de duas raízes em cada um deles. Uma vez realizada a abertura coronária, o preparo do terço cervical foi feito com a lima SX do sistema ProTaper® e a odontometria foi determinada e confirmada eletronicamente com o localizador apical eletrônico Root ZX. O preparo foi finalizado com a série de instrumentos do sistema ProTaper® e a obturação foi realizada com cones de guta-percha e cimento obturador resinoso sob a técnica Híbrida de Tagger. As radiografias finais mostraram dois canais bem obturados terminando nos limites apicais estabelecidos pelos localizadores apicais eletrônicos. O controle de 6 meses mostrou sucesso clínico e radiográfico do tratamento endodôntico. Os clínicos devem sempre considerar a presença de variações anatômicas em todo tratamento endodôntico. A despeito da baixa prevalência, pode haver variações no número de raízes e canais de caninos inferiores, como demonstrado neste caso clínico

Comparative study between 3D computed tomography, orthopantomography and periapical radiography for diagnosis of periapical lesions, root fractures and tooth resorptions

O pilar do sucesso do tratamento endodôntico é o diagnóstico e, para esse objetivo, a radiografia é um excelente recurso auxiliar, tanto pelo seu custo, como pela facilidade de obtenção. Contudo, ela tem suas limitações, pois trata-se da imagem bidimensional de um objeto tridimensional e daí a dificuldade encontrada no diagnóstico de lesões periapicais, fraturas radiculares e reabsorções dentais. Com o advento e o uso da tomografia computadorizada (TC), a partir de 1972, houve uma melhora na capacidade diagnóstica, com as imagens tridimensionais. Entretanto, a TC helicoidal tem limitações, na Odontologia, pelo seu custo, alta dose de radiação à qual o paciente é submetido pela presença de artefatos metálicos. Com a introdução da tomografia computadorizada na Odontologia, por meio do sistema de aquisição Cone Beam, essas desvantagens foram minimizadas, ocorrendo o aumento da qualidade diagnóstica da imagem tridimensional. O objetivo deste trabalho foi comparar a capacidade diagnóstica da tomografia computadorizada Cone Beam, utilizando o aparelho Accuitomo 3DX com as radiografias periapicais e ortopantomográficas (panorâmicas), em casos de lesões periapicais, fraturas radiculares e reabsorções dentais. Para isso, foram analisadas imagens obtidas por meio da tomografia e pelas técnicas radiográficas periapical e panorâmica de 150 casos clínicos, por dois examinadores calibrados, usando escores préestabelecidos. Os resultados permitiram afirmar que a técnica da tomografia apresentou diferença estatisticamente significante em relação às demais técnicas, no diagnóstico da extensão e localização de lesões periapicais, fraturas radiculares e reabsorções dentais.Diagnosis is the basis of success of endodontic treatment; radiography is an excellent aid for that purpose, due to both cost and easy achievement. However, it also has limitations, since it is a bidimensional image of a three-dimensional object; this explains the difficulty in the diagnosis of periapical lesions, root fractures and tooth resorptions. The advent and use of computerized tomography (CT) since 1972 improved the diagnostic ability with utilization of three-dimensional images. However, helical CT is limited in Dentistry, due to its cost, high radiation dose and presence of metallic artifacts. These disadvantages were minimized by introduction of the cone beam system in dentistry, which improved the diagnostic quality of three-dimensional images. This study evaluated the diagnostic ability of cone beam computerized tomography using the appliance Accuitomo 3DX, compared to periapical and panoramic radiographs, in cases of periapical lesions, root fractures and tooth resorptions. Images of 150 clinical cases were obtained by tomography and by periapical and panoramic radiographic techniques and evaluated by two calibrated examiners, using pre-established scores. The results revealed that the tomography technique presented statistically significant difference in relation to the other techniques for diagnosis of the extent and location of periapical lesions, root fractures and tooth resorptions

Apical sealing of root canal fillings performed with five different endodontic sealers: analysis by fluid filtration

OBJECTIVES: To evaluate the sealing ability of five root canal sealers, including two experimental cements (MBP and MTA-Obtura) using the fluid filtration method. MATERIAL AND METHODS: Teeth were divided into 5 study groups: G1-AH Plus; G2-Acroseal; G3Sealapex; G4-MBP; G5-MTA-Obtura; and two controls. Chemical-mechanical preparation was performed with ProFile rotary nickel-titanium instruments 1 mm short of the apical foramen. The sealing ability was evaluated by fluid filtration at 15, 30, and 60 days. RESULTS: The statistical analysis showed significant difference between the materials at different periods (p<0.05). AH Plus and MBP had similar leakage values at 15 and 60 days, alternating with significant reduction at 30 days, while the other materials showed progressive increase in leakage values. Acroseal and Sealapex presented the best results at 15 days and the worst at 60 days. CONCLUSIONS: All sealers evaluated presented fluid leakage, with AH Plus and MBP showing the best results at the end of the experimental period. Acroseal, Sealapex, and MTA-Obtura presented increase in leakage values at longer observation periods

Ultrasonic Chemical Vapor Deposition-coated Tip versus High- and Low-speed Carbide Burs for Apicoectomy: Time Required for Resection and Scanning Electron Microscopy Analysis of the Root-end Surfaces

This study compared ultrasonic chemical vapor deposition (CVD)-coated tip (CVDentus #8.1117-1; Clorovale Diamantes Ind. e Com. Ltda Epp, Sao Jose dos Campos, SP, Brazil) versus high-speed (#FG700L) and low-speed (#699) carbide burs for apicoectomy, evaluating the time required for resection and analyzing the root-end surfaces by scanning electron microscopy. Thirty extracted human premolars had the canals instrumented and obturated and were randomly assigned to 3 groups (n = 10), according to the instrument used for root-end resection. The time required for resection of the apical 2 mm of each root was recorded. The resected apical segments were dried, sputter coated with gold, and examined with a scanning electron microscope at X 350 magnification. A four-point (0-3) scoring system was used to evaluate the apical surface smoothness. The results were analyzed statistically by the Kruskal-Wallis test and two-by-two comparisons analyses were performed using the Miller test. The significance level was set at 5%. Root-end resection with the high-speed bur was significantly faster (p < 0.05) compared with the low-speed bur and CVD tip. The carbide burs produced significantly smoother root-end surfaces than the CVD tip (p < 0.05). The low-speed bur produced the smoothest root-end surfaces, whereas the roughest and most irregular root ends (p < 0.05) were obtained with the CVD tip. However, no statistically significant difference (p > 0.05) was found between the high- and low-speed burs regarding the surface roughness of the resected root ends (p > 0.05). In conclusion, under the tested conditions, ultrasonic root-end resection took a longer time and resulted in rougher surfaces compared with the use of carbide burs at both high and low speed. (J Endod 2009;35:265-268

Comparative study of cone beam computed tomography and intraoral periapical radiographs in diagnosis of lingual-simulated external root resorptions

Background: Owing to a lack of symptoms and difficult visualization in routine intraoral radiographs, diagnosis of external root resorptions can be challenging. Aim: The goal of this study was to compare two image acquisition methods, intraoral radiographs and cone beam computed tomography (CBCT), in the diagnosis of external resorption. Material and Methods: Thirty-four maxillary and mandibular bicuspids were divided into three groups. Perforations measuring 0.3 and 0.6 mm in diameter and 0.15 and 0.3 mm in depth, respectively, were made on the lingual root surfaces in thirty teeth, and four were used as controls. Next, teeth were mounted on an apparatus and radiographed at mesial, distal, and orthoradial angulations. CBCT images were also taken. The analysis of the intraoral radiographic and tomographic images was carried out by two experts using standardized scores. Data were then compared statistically. Results: A strong agreement between the examiners was observed in both diagnosis methods, the intraoral radiographic (r = 0.93) and the tomographic analysis (r = 1.0). Tomography had higher statistically significant detection values than intraoral radiography (P &lt; 0.05). In intraoral radiographs, the detection was significantly greater (P &lt; 0.05) in the mandibular bicuspids, compared with their maxillary counterparts. The ability to detect 0.6-mm perforations by intraoral radiography was significantly higher than that of 0.3-mm perforations (P &lt; 0.05). Conclusion: Cone beam computed tomography showed better diagnostic ability compared with intraoral radiography, regardless of the tooth or the dimensions of the resorption evaluated