Stomatological Hospital of Xiamen Medical College, Xiamen Key Laboratory of Stomatological Disease Diagnosis and Treatment, Xiamen, China.
Xiamen Medical College, Xiamen, China.
BMC Oral Health. 2024 Nov 19;24(1):1401. doi: 10.1186/s12903-024-05155-z.
The root canal systems of maxillary first molar (MFM) and maxillary second molar (MSM) variations represent a clinical challenge for endodontists, especially the prevalence of fused C-shaped roots. Having a thorough knowledge of root canal configuration is an extremely important point for a successful root canal treatment to avoid missing extra canals. The aim of this article was to present 2 cases of maxillary molar with an unusual C-shaped configuration diagnosed during root canal retreatment/treatment and conduct a literature review of the MFM and MSM anatomy. Case 1 reports that three separate palatal root canals fused into a C-shaped configuration in the MFM, which with an enamel pearl in the furcation, was classified as Type D and first reported in MFM. Case 2 reflects the fusion of all three buccal canals of the MSM into a C-shaped configuration that finally formed an apical foramen with a supernumerary tooth, and the configuration was Type B. Evaluation at an 18-month and a 9-month recall revealed that two patients were symptom-free after the conduct of a non-surgical retreatment/treatment, and the X-ray revealed normal periapical tissue. In addition, the thickness of the Schneiderian membrane due to odontogenic maxillary sinusitis returns to normal after an effective retreatment in case 1. These reports serve to remind endodontists of the importance and complexity of anatomical variations, which should always be considered when formulating an effective root canal treatment plan. The combined use of cone-beam computerized tomography (CBCT) and a dental operating microscope (DOM) will be profitable to locate and identify extra canals when a periapical radiograph shows signs of an unusual canal morphology.
上颌第一磨牙（MFM）和上颌第二磨牙（MSM）根管系统的变异给牙髓病医生带来了临床挑战，尤其是融合的 C 形根的发生率。深入了解根管形态对于成功的根管治疗至关重要，可避免遗漏额外的根管。本文的目的是介绍 2 例在根管再治疗/治疗期间诊断出具有异常 C 形形态的上颌磨牙病例，并对 MFM 和 MSM 解剖结构进行文献复习。病例 1 报告说，MFM 中有 3 个独立的腭根根管融合成 C 形，在分叉处有牙釉质珠，被归类为 D 型，这是首次在 MFM 中报道。病例 2 反映了 MSM 的所有 3 个颊侧根管融合成 C 形，最终形成一个带有额外牙齿的根尖孔，形态为 B 型。在 18 个月和 9 个月的随访评估中，发现 2 例患者在进行非手术再治疗/治疗后无任何症状，且 X 线显示根尖周组织正常。此外，在病例 1 中，由于牙源性上颌窦炎导致的筛状膜厚度在有效治疗后恢复正常。这些报告提醒牙髓病医生解剖变异的重要性和复杂性，在制定有效的根管治疗计划时应始终考虑到这些因素。当根尖片显示异常根管形态的迹象时，锥形束计算机断层扫描（CBCT）和牙科手术显微镜（DOM）的联合使用有助于定位和识别额外的根管。
