Balthazard Rémy, Corne Pascale, Vincent Marin, Mortier Eric
Department of Conservative Dentistry, Faculty of Dentistry, Vandoeuvre-lès-Nancy, France, Phone: +33 621 093 852, e-mail:
Department of Prosthodontics, Faculty of Dentistry, Vandoeuvre-lès-Nancy, France.
J Contemp Dent Pract. 2019 Feb 1;20(2):263-269.
The aim of this article was to promote a methodology in the endodontic management of complex premolars with multiple root canals Background: The success of endodontic treatment depends on a meticulous clinical and radiographic analysis, the creation of a suitable access cavity and chemical and mechanical preparation, followed by three-dimensional filling of the entire root canal system. Consequently, it is essential to look for the presence of additional root canals to prevent endodontic treatment failure Case description: Two cases are presented. The first case concerned a 50-year-old male patient of North African origin who consulted in the context of a global prosthetic restoration including endodontic treatment of the maxillary left first premolar (tooth no. 24). The second case concerned a 29-year-old male patient of North African origin who was referred to us by his primary care practitioner in an urgent context of pain and infection present for two weeks (tooth no. 44). In both cases, it was the in-depth radiographic analysis, combined with manual exploration under the surgical micro- scope, that led to the relatively rare identification of a third root canal. Shaping, disinfection and three-dimensional filling of the entire root canal system were then performed in accordance with widely validated protocols.
The maxillary and mandibular premolars, due to their highly variable root canal system configuration and a number of root canals and roots, appear to be teeth for which treatment is potentially complex. The acuteness of digital-tactile sense and the advent of 3D imaging and optical aids optimize the treatment of all the root canals of a tooth Clinical significance: These case reports demonstrate the importance of clinical and radiographic inspections to guide practitioners in the search for additional root canals in premolars and promote a methodological approach.
本文旨在推广一种用于复杂多根管前磨牙牙髓治疗的方法。
牙髓治疗的成功取决于细致的临床和影像学分析、创建合适的开髓腔以及化学和机械预备，随后对整个根管系统进行三维充填。因此，寻找额外根管的存在对于防止牙髓治疗失败至关重要。
介绍了两个病例。第一个病例是一名50岁的北非裔男性患者，因包括上颌左第一前磨牙（24号牙）牙髓治疗在内的全口修复前来咨询。第二个病例是一名29岁的北非裔男性患者，其初级保健医生在其出现两周的疼痛和感染紧急情况下将其转诊至我们这里（44号牙）。在这两个病例中，都是深入的影像学分析，结合手术显微镜下的手动探查，才相对罕见地发现了第三根管。然后按照广泛验证的方案对整个根管系统进行成形、消毒和三维充填。
上颌和下颌前磨牙由于其根管系统结构高度可变以及根管和牙根数量较多，似乎是治疗可能较为复杂的牙齿。指触感的敏锐度以及三维成像和光学辅助工具的出现优化了牙齿所有根管的治疗。
这些病例报告证明了临床和影像学检查对于指导从业者寻找前磨牙额外根管并推广一种方法学途径的重要性。
