radix entomolaris.pptx a rare case Series
- 2. 2 CASE PRESENTATION PRESENTER NAME :Dr.A.AISHWARYA RAJ CO PRESENTER NAME :Dr.R.DIVYAPRIYA Department of Conservative Dentistry & Endodontics MANAGEMENT OF RADIX ENTOMOLARIS
- 4. 4 ANATOMY OF MANDIBULAR FIRST MOLAR Five cusps - 2 buccal, 2 lingual and 1distal. The Crown is wider mesiodistally than buccolingually. Occlusal outline - Rectangular in shape. Two well developed root , one mesial and one distal
- 5. 5 Whenever the additional root suspected to presence during endodontic treatment of permanent mandibular first molar, modification of the access cavity preparation should be performed in order to ensure complete cleaning and obturation of all root canals, Otherwise the presence of missed canal can result in failure of the treatment.
- 6. 6 First described by Carabelli in 1844 and described by various terms, such as “extra third root” or “distolingual root” or “extra distolingual root” CARABELLI ANATOMICAL VARIATIONS OF MANDIBULAR MOLAR TOOTH
- 7. 7 CLASSIFICATION OF RADIX ENTOMOLARIS Type I : Straight root or canal. Type II : Beginning of the entry is curved and then continued as a straight root/root canal. Type III : Beginning of the entry is curved in the coronal third of the root canal with the presence of another curve started in the middle and continuing to the apical third.
- 8. 8 Prevalence of Radix Entomolaris The prevalence of radix entomolaris is reported to differ significantly with races and range from 0-33.1% Mongoloid traits such as Eskimo, Chinese, and American Indians -- 5- 30% Because of its high prevalence in these populations, the RE is considered to be a normal morphological variant (Eumorphic root morphology)
- 9. 9 Prevalence of Radix Entomolaris number of male number of female 0.00% 0.50% 1.00% 1.50% 2.00% 2.50% 3.00% 3.50% Series 1
- 10. 10 RADIX PARAMOLARIS Radix paramolaris (RP)is known as the “mesiobuccal root” (Carisen et al, 1991) and was fisrt described by bolk in 1915. Radix paramolaris is seen buccally to the mesial root and may found separate or fused with the mesial root.
- 11. 11 ETIOLOGY Etiology - Still unknown. In dysmorphic supernumerary root -- its formation could be related to external factors during odontogenesis, or to penetrance of an atavistic or polygenetic system ( atavism is the reappearance of a trait after several generation of absence) In eumorphic roots --Racial genetic foctors influence the more profound expression of a particular gene that results in the more pronounced phenotypic manifestation.
- 12. 12 Demographic Data PATIENT NAME :Mr. PALANISAMY OP.NO: 580187 AGE/SEX : 61/M PLACE: NAMAKKAL
- 13. 13 . Chief complaint: Patient complaints of pain in the lower right back tooth region for past one month. History of presenting illness: The pain is mild intermittent and its intensity increased during the past ten days Aggrevating factor: The patient was sensitive to hot and cold beverages. The pain aggrevated particularly at night .
- 14. 14 . Intraoral Examination: Fractured restoration in 46 Tender on percussion in 46 Radiographic finding: The pre-operative radiograph revealed radio opaque tooth filling material and radiolucency beneath it, involving pulp with widening of periodontal ligament with respect to 46.
- 15. 15 . Diagnosis: Secondary caries with symptomatic apical periodontitis in 46 Treatment plan: Patient advised for root canal treatment in 46
- 17. 17 . The tooth was anesthesized by using 2% lignocaine with adrenaline ACCESS CAVITY PREPARATION FOUR CANALS LOCATED - using DG-16 endodontic explorer locator Mesio buccal, disto buccal , mesio lingual and disto lingual with trapezoidal cavity preparation
- 18. 18 Magnifying loops was used during entire procedure Canals negotiated ISO size 8 K and 10 K files followed by working length determination with 15 K file apex locator and verified using peri apical radiograph Cleaning and shaping done using the Pro-Taper gold rotary file (SX, S1, S2, F1) file
- 19. 19 Irrigated using 2ml of sodium hypochlorite (5.25%) with double size vented 27 gauge needle in 3ml syringe for one minute and 17% EDTA solution as final rinse to remove the smear layer and finally flushed with sterile saline Master cone X-ray was taken using F1 gutta percha at its working length
- 20. Obturation was done using F1 gutta percha with Bioceramic sealer followed by post endodontic restoration with composite (A2 shade) Post obturation radiograph was taken to establish the quality of the obturation 20
- 21. 21 Pre operative radiograph Post operative radiograph Working length determination Master cone verification
- 23. 23 METAL CERAMIC CROWN CEMENTATION
- 24. 24 PRE-OPERATIVE VERSUS POST OPERATIVE
- 25. 25 Demographic Data PATIENT NAME :Mrs.VASANTHI OP.NO: 630533 AGE/SEX : 33/F PLACE: TIRUCHENGODE
- 26. 26 Case Series 2 Chief complaint: Patient complaints of pain in the lower right back tooth region for past one month. History of presenting illness: The pain is mild intermittent and its intensity increased during the past four days Aggravating factor: The patient was sensitive to hot and cold beverages. The pain aggravated while mastication
- 27. 27 Case Series 2 Intraoral Examination: Deep occlusal caries in 36 Tender on percussion in 36 Radiographic finding: The pre-operative radiograph revealed radiolucency extending from enamel , dentin and pulp with widening of periodontal ligament.
- 28. 28 Case series 2 Diagnosis: symptomatic irreversible pulpitis with apical periodontitis in 36 Treatment plan: Patient advised for root canal treatment in 36
- 29. 29 Case Series 2
- 30. 30 Case Series 2
- 31. 31 DISCUSSION
- 32. Same Lingual Opposite Buccal The image of tooth that is farther away from X-ray tube (lingual ) moves in same direction as tube and image of tooth closer to X-ray tube (Buccal) moves in opposite direction 1.Separation and identification of superimposed canals 2.Determination of curvatures. 3.Identification of undiscovered canals. SLOB RULE 32
- 33. Enhanced visualization Better magnification Larger field of view Wider depth of field MAGNIFYING LOUPES 33
- 34. The operative microscopes provides greater magnification and illumination & functions as an extension of loupes MICROSCOPE 34
- 35. 35 1.Better vision 2.Less changes of accidents like perforation 3.Agitation of NaOCl and EDTA ULTRASONIC TIP
- 36. CHAMPAGNE BUBBLE TEST Champagne bubble - employed to discover the hidden orifice. The chamber was filled with NaOCl and left standing for few moments. Under magnification using pair of loupes capable of magnifying an object ranging from 2.5x to 3.5x, tiny bubbles were visible in the solution indicating the position of the missing canal orifice. DG 16, used with moderate finger pressure at the site of bubbles, confirmed the presence of extra canal. 36
- 37. 37 CBCT Cone-beam computed tomography enables clinicians to accurately visualize the morphology of root canals, assess the number of canals, and establish the spatial orientation of any additional roots.
- 38. 38 CONCLUSION • Appropriate judgement for application of diagnostic tools and endodontic skills for management of radix entomolaris. • Careful interpretation of radiograph using different angulations and advanced tools such as magnifying loupes and operating microscope, CBCT may facilitate thier recognition.
- 39. 39 REFERENCES 1. Singh T, Bathla S, Dutta SK, Mohammed MA, Jethi N, Chansoria H, Pulluri SS. Morphological Variation of Mandibular Molars in Rohilkhand Population: An Original Research. Journal of Pharmacy and Bioallied Sciences. 2024 Feb 1;16(Suppl 1):S632-6. 2. Arora A, Arya A, Chauhan L, Thapak G. Radix entomolaris: Case report with clinical implication. International Journal of Clinical Pediatric Dentistry. 2018 Nov;11(6):536. 3.Shukla P, Sharma V, Bedi RS, Acharya S. Management of Radix Paramolaris With a Distal Canal in the Mandibular First Molar: A Case Report. Cureus. 2023 Mar 15;15(3). 4.Thomas BJ, Nishad A, Paulaian B, Sam JE. Case reports and clinical guidelines for managing radix entomolaris. Journal of Pharmacy and Bioallied Sciences. 2016 Oct 1;8(Suppl 1):S160-3.
- 40. 40 THANK YOU