Patient Bill Of Rights Root Canal Anatomy Of The Permanent First Molar

Nestor Cohenca, D.D.S., FIADT

3/12/2024

Root Canal Anatomy Of The Permanent Mandibular First Molar. Clinical Implications And Recommendations

The world of endodontics has incorporated new technologies, instruments and materials in the past decade. Among them, operating microscopes, digital radiography, cone beam computed tomography (CBCT), 3D nickel titanium files, sonic and ultrasonic instruments and new irrigation delivery systems. However, despite all these improvements, the overall outcome, especially of non-surgical endodontics, has not increased significantly. Why? If we think critically, there are two important factors directly related to prognosis on which our advancements were limited: predictable eradication of microorganisms and access to the full anatomy of the canal system in which they might be harbored.

The mandibular first molar is the more frequently endodontically treated tooth. In a study by Swartz et al, the success rate of endodontically treated teeth was 87.79%, demonstrating the mandibular firs molar a significant lower success rate of 81.48%. It is well accepted that a unique cleaning and shaping technique is not suitable for all cases. Therefore, the endodontist should be able to fully understand the tooth morphology and root canal configurations in order to select the most appropriate treatment modality for a particular case and increasing the healing rate.

Number of roots

Review of the literature revealed a strong correlation between the presence of a third root in 13% of teeth and the ethnicity of the patients, particularly Asians, Mongolians and Eskimos. This macrostructure was term radix entomolaris with high variation regarding the coronal, mesio-distal plane. When the position of this third root was buccal, it is called radix paramolaris. Its shape and curvature are highly variable. Several radiographic exposures are required to clearly observe the presence of additional roots. Treating a mandibular first molar without initial off-angle radiographs could lead to third roots go unnoticed (Fig 1). Initially, a file located in the extra root, may give the appearance of a perforation. To prevent mishaps, it is advisable to choose a small and highly flexible instrument when treating the apical portion.

Number of root canals

In a systematic review compiling data on 4,745 mandibular first molars, three canals were present in 61.3%, followed by 4 canals in 35.7% of cases and 5 canals in almost 1% (Fig 2). However, in vivo studies performed by endodontists demonstrated the presence of 4 canals in 45% of the treated cases. Five canals were found in 0.8% of the samples while case reports have demonstrated the possibility of six and even 7 root canals.

Conclusions

  1. The number of roots in the first mandibular molar is directly related to the ethnicity of the population studied.
  2. The instrumentation of the third root requires a different access and the use of small and flexible instruments, considering the curvature at the apical third.
  3. Mesial roots present 2 canals on a regular basis, adopting 2-2 and 2-1 as the most frequent configurations. A third canal might be present in 2.6% of the population.
  4. The most common configuration in the distal root is 1-1 (62.7%), followed by 2-1 (14.5%) and 2-2 (12.4%).
  5. Access modifications are required in order to find extra roots and/or canals.
  6. The presence of isthmuses reaches 55% in the mesial root and 20% in the distal. This anatomical configuration should be taken into consideration during endodontic treatment as well as during periapical surgery.

Nestor Cohenca, DDS, FIADT

Diplomate. American Board of Endodontics

PS. Full references available per request.

I had my second root canal in a week performed by a very caring and skilled Dr. Cohenca. I can honestly say the experience was much easier and painless than I feared. In fact it was a lot like getting a cavity filled, just takes longer, about an hour. I was able to leave the office and go for a pain-free cold smoothie on the way home! The Dr. clearly explained the procedure with images, and I could see the before and after X-rays. He was assisted by skilled and compassionate professionals who made sure I was comfortable throughout the procedure. The front desk staff is very competent as well.

D.O. Yelp

If you need a root canal, look no further. Dr Cohenca is the only endodontist I will go to for root canals. I have had so many traumatic ones over the years, but for my last 2(which were repairs of old root canals), he fixed me right up. So professional, yet so sweet and caring. I believe him to be the best out there! He is honest and lets you know exactly what is going on, as well as having a dental office with the latest and greatest technology so you can even watch your own procedure.

H.M. Google

Was able to visit this clinic in two different occasions and I recommend Prime Endodontics, very professional staff, very caring, they made sure I was comfortable and my dental procedure was excellent, I Receive a post-op call after each visit to check on my progress, that is something I really appreciate. My dentist informed me that he refer me to this clinic because of the good comments and excellent ratings, I can confirm that it is true and I do recommend this clinic.

D.R. Google

Dr. Cohenca is so highly skilled & excellent at what he does. I had a very challenging root canal, and was very anxious. I needn’t have been - I experienced very minimal discomfort during and after the procedure. His staff was great - just couldn’t have asked for more. I would recommend Dr. Cohenca highly!!

D.K. Google

I have had nothing but positive experiences at Prime Endodontics. Dr.Sahrd Nawari was especially adept at explaining the procedures and monitoring my comfort level and anxiety. have seen both doctors and they provide gentle care and my comfort came first. I highly recommend them.

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