Himanshu Jain and Nidambur Vasudev Ballal*
Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal University, Manipal, Karnataka, India
Received: 30 January, 2016; Accepted: 09 February, 2016; Published: 11 February, 2016
Dr. N. Vasudev Ballal, BDS, MDS, PhD, Professor, Department of Conservative Dentistry and Endodontics, Manipal College of Dental Sciences, Manipal, 576104, Manipal University, Karnataka, India, Tel: 91- 0820-2922172; Fax: 0091-820-257006; E-mail:
H Jain, Ballal NV (2016) Endodontic Management of Aberrant Root Canal Anatomy in Premolars - A Report of Two Cases. J Dent Probl Solut 3(1): 008-011. 10.17352/2394-8418.000025
© 2016 H Jain, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Bayonet shaped canals; Multiple canals; Root canal anatomy; Root canal instrumentation
Premolars are recognized for their aberrant root canal anatomy. The unique feature of dilacerations and multiple root canals pose utmost challenge in the endodontic management. A clinician is required to have an insight of the morphology of tooth related to its shape, form and structure prior to commencing root canal treatment. This article describes the endodontic management of two cases of aberrant root canal anatomy in premolars.
Root canal anatomy is a highly complex with over time clinicians missing canals, or unable to negotiate them properly. The successful outcome of an endodontic treatment demands the thorough knowledge of the internal anatomy of the root canal system [1,2]. Failure to recognize the variations in root canal anatomy may result in unsuccessful endodontic outcomes. Even in teeth with a low frequency of abnormal root canal anatomy, the possibility of additional root canals has to be considered in the clinical and radiographic examination of the patient. The incidence of number of roots and the number of canals which have been reported in the endodontic literature greatly varies [3,4]. Dilacerations refers to an angulation that may occur anywhere along the length of the tooth (crown or root) [5,6]. Root dilacerations may occur either unilaterally or bilaterally . The direction of root dilacerations should be considered in single or double planes. They can be categorized as mesial, distal, labial/buccal, or palatal/lingual . If the roots bend mesially or distally, the dilaceration is clearly apparent on a periapical radiograph. However, when the dilaceration is toward the labial/buccal or palatal/lingual, the x-ray beam passes through the deflected portion of the root in an approximately parallel direction. The dilacerated portion then appears at the apical end of the unaltered root as a rounded opaque area with a dark “spot” in its center that is caused by the apical foramen of the root canal. This appearance has been likened to a bull's-eye or a target appearance. When the root dilaceration is in labial direction, it is called a scorpion tooth. If a tooth is doubly affected, it is called as a bayonet dilaceration . Bayonet shaped root canal are also called as “S” shaped canal which has two curvatures. The apical curvature in bayonet shaped root canal is very difficult to negotiate and may lead to strip perforation during instrumentation. Premolars often have very complex root canal anatomy and morphology with finely tuned and synchronized small tributaries running all through the length of the root canal making it challenging for the clinician to treat them effectively . Clinicians have commonly encountered with bifurcating canals, multiple foramina, fins, deltas, loops, cudle-sacs, inter-canal links, and accessory canals in premolars.
This paper describes the endodontic management of premolars with anatomic variations in the root canals that were identified during routine endodontic treatment.
Case Report 1
A 19-year-old female patient reported to the Department of Conservative Dentistry and Endodontics, with the chief complaint of food lodgment in her upper right and lower left back tooth. There was associated history of mild pain while bitting. Her medical and family history was noncontributory. Intra oral examination revealed a deep carious lesion with respect to the mandibular right second premolar (45) and maxillary left first premolar (24). On evaluation of the pulp status, both the teeth showed no response with heat (gutta-percha stick), cold (ice piece) and electric pulp testing (Parkell Electronics Division, Farmingdale, NY). The teeth were tender to percussion suggestive of symptomatic apical periodontitis. Intraoral periapical radiograph (IOPA) in relation to 45 and 24 revealed deep proximal caries involving the pulp (Figure 1). There was also widening of periodontal ligament space confirming the diagnosis of apical periodontitis in both the teeth. Root canal treatment for 45 and 24 was planned out. Intraoral periapical radiographs revealed the presence of double curved canals (S shaped) in both the teeth suggestive of bayonet shaped canals.