|ROOT CANAL ANATOMY: |
EXPECT THE UNEXPECTED!
As a resident, I could spit out every percentage of every possible anatomic possibility of every tooth in the arch. There were several key articles we all memorized and believed as gospel that told us how many canals to look for in each tooth. Ask anyone who stayed awake on day 1 of Dental Anatomy class in Dental School "how many canals in a maxillary first bicuspid?" and you will surely hear a confident "2 canals"!. Of course we all know by now that the dreaded MB2 lurks in just about every max molar we encounter.
So how many canals should one expect to find when treating an "easy" lower anterior? Using a microscope does provide some advantage but many of us are doing endo without the help of this level of magnification. So are we calling off the dogs when we find "the canal?" Or in a case like this one where we fully expected 2 canals, are we satisfied with just that? I was, and quickly learned 2 lessons I would never forget:
1. "Expect to find 10 canals in every tooth you treat". If you go in looking for 1, more than likely you will find 1. Looking for 2 will likely get you 2 (see below).
I can tell you from experience that looking for 4 canals in a maxillary molar will often lead to a missed second palatal canal (see below). Spending a few extra minutes scouting a clean chamber and debrided canals can pay off big time in the end.
2. "Never underestimate the power of the SLOB rule!!"
Of course a 3D scan would reveal certain anatomical variants we may otherwise miss. However, I saw no apparent indication to have this tooth scanned. It truthfully seemed "straight forward". So imagine my surprise when I had my 2 master cones in, took my angled radiograph and saw a possible third canal filled with a stream of sealer in this "straight forward" lower anterior incisor. (Trying in cones with sealer can be very useful in finding things we may have overlooked).
OK so now to the good part. This is truly endo porn! As far as i know, there are no documented cases with 3 separate canals in a lower anterior incisor. What luck to have this tooth fall on my lap. This tooth taught me several valuable lessons.
Vertucci eat your heart out, and everyone else keep your eyes peeled in every tooth you put a file in!
THE ENDO FILES ARE INTENDED TO BE AN INFORMAL, INFORMATIVE AND POSSIBLY ENTERTAINING ACCOUNT OF CASES SELECTED BY DRS GARCIA AND PEGUERO. SOME CASES WERE SUCCESSFUL, AND OTHERS NOT. HOWEVER EVERY CASE SELECTED WILL HOPEFULLY OFFER THE READER A PEAK INTO THE MIND OF THE ENDODONTIST WHEN THE "GUTTAPERCHA HITS THE FAN"!
WE HOPE YOU LEARNED SOMETHING....WE DID!