AlTamimi Eyad A, Agwan Muhammad Atif S, Ahmad Muhammad Z
Department of Conservative Dental Sciences, College of Dentistry, Qassim University, Buraydah, SAU.
Cureus. 2024 Nov 11;16(11):e73466. doi: 10.7759/cureus.73466. eCollection 2024 Nov.
Teeth may exhibit a wide range of anatomical variations in their roots and root canal systems, making them challenging to treat in endodontic procedures. Generally, maxillary canines and mandibular premolars present with a single root with one canal, and variations are comparatively rare. Achieving a fluid-impervious seal in endodontic therapy requires thorough debridement and three-dimensional obturation of the root canal system, which is considered a complex micro-neurologic procedure. Clinicians may fail to achieve the successful outcome without a comprehensive understanding of the pulp chamber and root canal system anatomy. We present a report of successful management of previously failed root canal treatment of two such cases, a maxillary canine and a mandibular premolar, with a previously missed second canal due to their uncommon root canal morphological presentation. This report also comprehensively reviews the literature, focusing on the clinically significant anatomical variations and detailing techniques for the effective management of such anomalies in endodontic treatment. The review provides an in-depth explanation of each stage of treatment, including preoperative diagnosis, intraoperative identification of morphological variations, and evidence-based modern endodontic treatment approaches. Emphasis is placed on ensuring a thorough understanding of these steps to achieve successful outcomes in the management of complex cases involving root canal anatomical variations.
牙齿的牙根和根管系统可能呈现出广泛的解剖变异，这使得它们在牙髓治疗过程中具有挑战性。一般来说，上颌尖牙和下颌前磨牙通常有一个牙根和一个根管，变异相对较少。在牙髓治疗中实现不透液的封闭需要对根管系统进行彻底清创和三维充填，这被认为是一个复杂的微神经学过程。如果临床医生对髓腔和根管系统的解剖结构没有全面的了解，可能无法取得成功的治疗结果。我们报告了两例先前根管治疗失败的病例（一例上颌尖牙和一例下颌前磨牙）的成功处理情况，由于它们不常见的根管形态表现，之前遗漏了第二条根管。本报告还全面回顾了文献，重点关注具有临床意义的解剖变异，并详细介绍了牙髓治疗中有效处理此类异常的技术。该综述对治疗的每个阶段进行了深入解释，包括术前诊断、术中对形态变异的识别以及基于证据的现代牙髓治疗方法。重点是确保对这些步骤有透彻的理解，以便在处理涉及根管解剖变异的复杂病例时取得成功的治疗结果。
