Keywords:Maxillary Second Molar, Single Root, Single Canal Morphology,dental laser tips
1. Introduction
Successful endodontic treatment of teeth requires knowledge related to root canal morphology. Maxillary second molar is similar to maxillary first molar, which is smaller in all parameters. Maxillary second molar usually has three root canals of which two are on the buccal side and correspond with its roots, and palatinal canal which also corresponds with this root [1] .
Cases of maxillary second molar with two palatal roots [2] , four roots [3] , three bucal roots [4] and five roots [5] have been previously reported in literature. Variations have also been reported in the form of fewer or lesser number of canal [6] .
These roots have internal anatomic variations and might usually have a C-shaped canal configuration [7] .
Fava et al. [6] reported a single root and a single canal on the maxillary and mandible second molar. This feature is more often on lower mandible molars, but it can also appear on maxillary molars, other molars and premolars. Therefore, the majority of studies related to variations of maxillary molars are related to first molar since variations of maxillary second molar are rare.
There are various methods applied to describe complicated configuration of teeth root such as: longitudinal and transversal teeth projection, the system of root canal traces with resin and silicon, the technique of irrigation of canal by injecting hematociclyne and india ink color, in vivo and ex vivo research, radiographic assessment, application of electronic microscope, application of operative microscope and a loop, computer three-dimen- sional reconstruction and micro-computerized tomography [8] .
The aim of this clinical case presentation was to describe the unusual anatomic area of maxillary second molar.
A 25-year-old female patient visited the Department of Conservative Dentistry and Endodontic in University Dental Clinical Center of Prishtina, Kosovo. Clinical examination revealed occlusal composite restoration. Her primary complain, was spontaneous pain on the left maxillary second molar. The tooth was sensitive in vertical percussion, coldness and warmness. Pain appeared more frequently during the night lasting 2 to 3 hours with brief calming periods. The clinical examination was associated with radiographic (Sirona Siemens, Germany) and orthopamographic imaging (Owandy, France).
As mentioned, in the radiographic and orthopantomographic (OPG) image of both maxillary second molars was observed an unusual morphology. Both maxillary molars had only one root with a single apex and a single wide canal localized in the central part of the root, (anatomic classification according to Fan) , compared to mandible second molars, which had a normal root and canal morphology (two roots, three canals) .
After plexus anesthesia Articaine HCl. 4% with Epinephrine 1:100,000 Injection (Septocaine, Septodont, France), the cavity was opened. After removal of the restoration the trepanation was done. Working length was determined by Apex locator (Dentaport, Morita, Japan). Root canals were cleaned and shaped using K-Files (K-Reamers, Edenta le, Swiss) with conventional method. After each instrumentation the canal was irrigated with 2.5% NaOCl solution (Sodium Hypochlorite Solution, Sigma Aldrich-Germany). The inorganic component was removed with EDTA (Ethyilendiamine tetra acetic, acid disodium salt dehydrates, Czech Republic) solution with 17% concentration and final irrigation was done with a physiological solution NaCl 0.9% (B-Braun, Germany). After tooth canal instrumentation the root was dried with a sterile paper point. The gutta-percha (Dia Dent, Korea) was placed with a temporary filling to conduct a test image.
After the imaging the teeth root canal was obturated with cold lateral guttapercha with Canason (Vocco, Germany) and a lateral condensation of gutta-percha. To verify the filling, the patient’s tooth was imaged again .
3. Discussion
The variation of maxillary second molar with single root and single canal is easily to detect in routine radiographs,dental laser as in this case. The use of multi angled diagnostic radiographs may be very useful on diagnosis of typical cases. However, care should be taken to assess the correct anatomy on the preoperative radiograph. In this way, we can reduce confusion with another anatomic variation of the same tooth where two roots are present (bucal and palatal), that could be superimposed on the diagnostic radiograph.
4. Conclusion
Nexhmije Ajeti, Violeta Vula, Sonja Apostolska, Teuta Pustina, Tringa Kelmendi, Lindihana Emini, Shefqet Mrasori, Resmije Ademi Anatomic variations such as: fusion, germination or anomalies of tooth root can often be diagnosed by radiography. Therefore, the usage of various angulations during radiographic imaging assists us in revealing these un- usual cases in tooth root and canal. The use of CBCT provides new capabilities for assessment of the morphology and root anatomy of molar teeth. CBCT must be used in those cases where the conventional radiographic examination is not conclusive concerning the presence or absence of a supernumerary root. Even though the occurrence of maxillary second molar with a single root and a single canal is not high, diagnosing these unusual cases is of tremendous importance for successful endodontic treatment of these teeth.