Any technology that can help a dentist, in procedural step by step endodontics, is not enough if a dental surgeon is unable to locate a specific orifice, latent canal or associated root canal system. Therefore, technologies that assist in the perception and diagnostics are helpful in an advanced identification of aberrant root canals or previously unidentified canal.
Though root canal treatment is a complicated procedure and may involve multiple visits to the clinic, the dentist performs repeated mechanical preparation of the root canal, validating the detection of any given orifice. The following write-up represents the anatomical considerations for dental implants and the strategy and technique for locating canals within various tooth categories.
Anatomical considerations and landmarks for a dental implant or endosseous implant take care of everything before and while placing a dental implant or fixture. Considering various tooth groups, here is a review of root canal morphology.
#1 Maxillary Incisors (Central and Lateral)
Maxillary incisors are four in number. These teeth can show dens in dente or dens invaginatus, which means a tooth within a tooth. Central and lateral maxillary incisors are alike in anatomy and correlate in functions. Their prime purpose is to cut food.
#2 Maxillary First and Second Bicuspids
Maxillary first bicuspids or maxillary first premolar have distinct lingual and buccal roots. However, the second bicuspids or second premolar have a sole, broad root computed buccal to lingual. First bicuspids radiographically unveil distobuccal, mesiobuccal and palatal roots, at times. Second bicuspids commonly have a ribbon-shaped orifice, with deep canal divisions.
#3 First and Second Maxillary Molars
Maxillary molars are the largest in the maxillary arch. They erupt at the age of 6 with crown and four developed cusps. Maxillary first molars have more than one system in the messiobucal (MB) root 90% of the time. However, second maxillary molar are supposed to have a second canal in the messiobucal root.
#4 Mandibular Incisors
Being four in number, central mandibular incisors are positioned in the centre mandible. However, second incisors or mandibular lateral are distal to the central incisors. They have broad roots, which can hold a second lingual canal for 45% of the time.
#5 Mandibular Bicuspids
Mandibular premolar or mandibular bisuspids maintains complex root canal systems, exhibiting one root. This group of teeth has deep divisions, many apical portals, displaced orifices and branches, but occasionally extra roots are recorded.
#6 Mandibular Molars First and Second
With significant anatomical variations, sometimes the medial root of this teeth group holds a third system that may be located in the trench between the mesiolingual and the messiobucal opening, fissure or crack. In some cases, the wide distal root which inculcates the second canal.
#7 C-Shaped Molars
Peculiarly found in the mandibular second molars, they exhibit recognisably different features and radiographically a fused root, cul-de-sac furcation and a pulp chamber.
Strategies for Detecting Canals
#1 Radiographic Diagnostics
Radiographic representations are used to diagnose and observe dental diseases and dentofacial development. However, the best conventional film or digital imaging of a 3D object is often a 2D representation of the same. Therefore, a well-angulated periapical radiograph should be captured from three different horizontal stages. Sometimes more angular view can reveal another canal issue.
CBCT or Cone Beam Computed Tomography is a boon regarding radiographic diagnostics, disclosing anatomy and help in preserving tooth structure during ingress preparation.
#2 Piezoelectric Ultrasonic
Piezoelectric ultrasonic materials differ in corporal properties. It is a more compact way of diagnosis, as ultrasonic handpiece banishes the use of huge traditional handpiece that obstructs the vision of the operator. This is a highly reliable and no pain technology.
#3 Surgical Length Burs
Carefully designed surgical burs provide a combination of flute depth and spiral angulations for better line of sight and safety. The extra long length of the device promotes tooth structure preservation while locating canals. Surgical burs are ideal for withdrawal and root canal procedure.
#4 Transillumination Test
Transillumination is a test performed with a bright light, in a dark room, to see through canal or cavity. This is known as one of the fastest procedures, as it requires no preparation and thoroughly painless. A fibre optic stick positioned cervically and directed perpendicularly to the axis of a tooth is used to identify orifice in transillumination process.
#5 White Line Test
Executing ultrasonic procedures without using water in necrotic teeth often helps dentinal grime settle down in any accessible crack or anatomical space. The white line or white spot formed in an orifice can be easily mapped with white line test.
#6 Bubble Test
Allowing sodium hypochlorite or NaOCI to stay in the pulp chamber helps to detect a calcified orifice. Tiny “bubbles” or “champagne” appearing in the solution indicates the exact position of the root canal orifice.
#7 Restorative Disassembly
While preparing to access canal for retreatment, the coronal disassembly improves alignment, vision and anticipation of identifying the deepest orifice safely.
#8 Explorer Pressure
If the handpiece used during the endodontic process is thin and strong, with a pointed tip, it is the safest way to locate more mineralised cervice.
The pulp pocket can easily be identified with a methylene blue water-soluble dye. The cavity chamber is washed, dried and made visible for further diagnosis.
Endodontic access can only be successful if done with proper visualisation. Any missed canal or suspected hidden cavity can be easily cured if you can see it. Always go to Abbotsford dental clinic and have your teeth check by your favorite dentist.