01 April 2022

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Clinical case of non surgical endodontic retreatment of maxillary second molar with unusual anatomy

Authors: Massimo Amato, Dina Abdellatif, Alfredo Iandolo

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Bacteria and their byproducts are the main cause of infection of the pulp and the periapical area. An accessory root (also known as supernumerary root or additional root) is one of the most common variations of root anatomy in maxillary molar teeth. The present case report discussed the endodontic retreatment of a maxillary second molar with an unusual anatomy showing a fifth canal in a small accessory distinct root situated in the center of the pulp chamber floor. Such peculiar morphological variation has never been reported in literature.

MATERIALS AND METHODS

A 32-year-old male patient was refer- red for evaluation and possible retreatment of right maxillary second molar. Clinical examination revealed pain at the percussion test. The tooth was diagnosed with failed root canal treatment and non-surgical endodontic retreatment was planned. After isolation with rubber dam, access cavity was done under the operating microscope. After identification of the tooth anatomy and the complete canal system scouting, the endodontic retreatment was performed with mechanical rotary instruments and irrigation with 5.25%

NaOCl, 17% EDTA, saline solution and chlorhexidine CHX 2% as a final wash. The obturation of the canal system was performed with thermoplasticized guttapercha using system-B technique. The postoperative radiograph showed complete obturation of the five root canals, including the small accessory root canal. The first follow-up was done after 12 months and the radiograph sho- wed successful root canal treatment. A CBCT of the upper arch was done at nine year follow-up and revealed complete healing of the tooth. A 3D reconstruction showed the peculiar anatomy with 5 root canals.

DISCUSSION

The maxillary molars can be present in nature with different morphological configurations. The present case report described a maxillary second molar with an uncommon root canal morphology. The particularity of the tooth is the presence of a small auxiliary root located at the center of the floor. The use of an optical microscope is important to improve the power of resolution and the employment of ultrasonic tips offers an enhanced precise cutting due to their reduced dimensions which permits greater visibility of the operating field when compared to rotary instruments. Therefore, proper knowledge of the anatomy and an optimized operating field help in the identification of all root canal orifices, in order to proceed with the shaping, cleaning and three dimensional obturation phases.

CONCLUSIONS

Achieving success in endodontics depends primarily on proper knowledge of morphology and possible variations of the root canal system of the teeth. However, it is fundamental to use modern updated technology and adequate instrumentations to achieve long lasting results.

CLINICAL SIGNIFICANCE

Achieving successful root canal treatment mostly depend on proper cleaning, shaping and 3D obturation of the root canal system. Improper cleaning of the entire root canal system could lead incomplete removal of the pulp tissue and failure of the treatment. Furthermore, even worse results could occur if an entire undiscovered root canal is missed. The precise knowledge of the root canal anatomy is essential for ensuring the success of the endodontic treatment and/or endodontic retreatment.