Graduated 2003 from Faculty of Dental Medicine, Mansura University, Egypt.
Moved to Saudi Arabia 2007, working in Bisha Dental Center, Assir region, Saudi ministry of health. Since that time practice is limited to Endodontics.
Trainer and Course provider in Advanced Endodontics-Bisha training center.
Mandibular Premolars: Teeth not to underestimate
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The operator should be able to assess the endodontic case and know about tooth anatomy and the suspected anatomical variations one may face during treatment.
Access opening of mandibular premolars usually is oval shape extended buccolingually with orifices located under B,L cusps.
Floor anatomy: visualization of floor anatomy and map will help in detection of extra canal orifices if exist. Either the use of long shafted bur mounted on low speed hand piece or ultrasonics could be used to detect hidden or extra canal orifices with less damaging to tooth structure (14). The use of Dental Operating Microscope with good illumination will significantly improve the access cavity preparation and allow easier detection of canal orifices (15).
The Use of EDTA during negotiation will allow easier movement of the files along canal walls (16). The operator should be aware of any stoppage for the negotiating files during the gentle movement on the canal walls which might be an indication of presence of another canal or split. Careful moving of the precurved files along the canal walls in multiple direction without any estimation the extra canal should be here or there will allow easier detection of the entrance if canal located in unsuspected place. (Precurving also should be tried at smooth and sharp angles).
RCT is a dynamic process, Extra canals could be detected during any phase of treatment, The Operator should be aware of any slippage of rotary or reciprocating files in different direction during this process. Controlled Memory files is a greet tool for managing canal splits and deep divisions as it’s prependable so it can be used to mechanically clean and shape these canals without the need of sacrificing more coronal dentin (17).
Careful reading to Radiographic image at that time is so important for inspection of seepage of obturation material in different direction could indicate the presence of extra canals (the operator should be able to differentiate between lateral or accessory canals and missed main canal).
If the root canal filling outline doesn’t coincide with or conform the external root geometry or the periodontal ligament space, this might be an indication of missed anatomy.nIn these situations, Retreatment might be considered.
Mandibular premolars can exhibit complex and aberrant root canal anatomy which is of a great challenge to diagnose and to manage during root canal treatment.
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