Endodontic management of the maxillary first molars with two root canals: A case report and review of the literature

BACKGROUND The complex anatomy of the maxillary first molars has always been a major challenge for complete root canal treatment in endodontic therapy. Here, we present two cases of maxillary first molars, each with only two root canals, which have been rarely reported. We also perform a literature review of maxillary first molar anatomy.CASE SUMMARY The two patients were referred to the hospital after 1) finding a cavity in their tooth with a color change and, 2) a toothache during mastication, respectively.Both of these cases were diagnosed as apical periodontitis by X-ray imaging and cone beam computed tomography(CBCT). Non-surgical endodontic therapy was performed with the assistance of a dental operating microscope(DOM). CBCT showed rare but accurate images of both patients, each with two root canals and two roots in their maxillary first molars. Both roots were located in the buccal in the palatal direction, and each root had only one clear root canal. In addition,each maxillary first molar in both patients was symmetrical to that on the opposing side with only two separate root canals. Non-surgical endodontic therapy was performed with the assistance of a DOM. Finally, the teeth were restored using composite resin and the patients were satisfied with the results.CONCLUSION Making full use of CBCT and DOM would contribute to helping dentists make correct diagnoses and successfully treat teeth with rare root canal morphologies.

Fracture resistance and pattern of the upper premolars with obturated canals and restored endodontic occlusal access cavities

We studied whether obturing canals and restoring endodontic occlusal access cavities on upper premolars could provide acceptable resistance and pattern to fracture.Eighteen upper premolars were divided equally into 3 groups.Group 1 consisted of intact controls;group 2 had access cavities and root canal preparations;group 3 as in group 2 but obturated with gutta-percha and AH26,and the access cavity restored with glass ionomer and composite.Specimens were submitted to compressive strength testing using the Hounsfield Universal H50KM testing machine with a load cell of 2000 Newtons and a crosshead speed set at 1.0 mm/min until fracture.The results from the compressive strength tests showed that intact controls （1105.83±90.93 MPa） and restored premolars （936.67±44.67 MPa） were significantly different from premolars with unrestored access cavities 568.33±105.49 MPa.There was no significant difference between intact controls and restored premolars.The predominant fracture pattern for intact teeth was an oblique fracture.For premolars that had endodontic access cavities,restored or unrestored,the most common fracture pattern was a vertical fracture.The restoration of occlusal access cavities with glass ionomer and composite provided fracture resistance close to that of intact controls,but when restored teeth fractured,they were predominantly non-restorable.

Super number roots and factorizations for a kind of polynomial

It is widely known that the equation 2xx= has and only has two roots 0 and 1. Jiglevich A.B. and Petrov N. N. discovered that equation has two other roots, i.e. infinite place’s numbers (called super numbers): 8212890625X=L and 1787109376Y=L, and obtained 4 (super number) roots of the equation2xx=. For progressing to wider conditions, with the way of exactly divisible and mutually orthogonal Latin squares, three attractive results are obtained: 1) A kind of polynomial 1()()niiPxxa==P-, ,1,2,,iain?KZ has and only has different n2 super number roots; 2) When n>2 and n 6, those n2 roots of the polynomial ()Px can be arranged in an n-order square matrix, of which n roots of every row and every column satisfy Vieta Formula of roots and coefficients; 3) In *Z ring of super number, the polynomial1()()niiPxxa==P-, ,1,2,,iain?KZ has n! different factorizations.

Endodontic management of the maxillary first molar with special root canals:A case report and review of the literature

BACKGROUND As the complex anatomy of maxillary first molars is one of the major challenges in endodontic therapy,knowledge of the complicated root canal anatomy and configuration is crucial to ensure the success of endodontic treatment and prognosis.This article presents an endodontically managed left maxillary first molar with an unusual palatal root morphology.The available literature on the anatomic variation of maxillary first molars is also reviewed.CASE SUMMARY A 36-year-old man with no medical history presented to the Stomatology Department of Peking University Third Hospital complaining of a toothache during mastication in the maxillary left posterior region for approximately 3 mo.He had a spontaneous and intermittent toothache that had worsened,particularly at night.The diagnosis based on clinical examination,X-ray imaging,and cone beam computed tomography(CBCT)was symptomatic irreversible pulpitis.Nonsurgical endodontic therapy was performed for the left maxillary first molar.Five root canals revealed by CBCT included a special palatal root canal(1-2-1-shaped),two mesiobuccal root canals,and one distobuccal root canal.Evaluation of the CBCT images confirmed the root canal morphology and the clinician performed more effective cleaning,obturation,and therapy.Finally,the tooth was restored using composite resin,and the patient was satisfied with the result.CONCLUSION CBCT and a complete review of the literature may be beneficial for investigating the root canal system to achieve a biological and functional therapeutic effect.

Incidence of C-shaped root canal systems in mandibular second molars in the native Chinese population by analysis of clinical methods

The aims of the study were to investigate the incidence of C-shaped root canal systems in mandibular second molars in a native Chinese population using radiography and clinical examination under microscope and to compare the relative efficacies of these methods. For the recognition of C-shaped root canal system, 1 146 mandibular second molars were selected and examined. Teeth with C-shaped canal systems were categorized by using the radiographic classification criteria and the modified Melton＇s method. C-shaped canals were identified in 397 （34.64%） mandibular second molars by radiography （type I, 31.23%; type II, 38.29%; type III, 30.48%）. Clinical examination showed that 449 （39.18%） cases exhibited C-shaped canal systems （C1, 22.94%; C2, 48.11%; C3a, 15.59%; C3b, 13.36%）. As for the result of the radiographic and clinical combined examination, C-shaped root canals were found in 473 （41.27%） mandibular second molars （C1, 21.78%; C2, 45.67%; C3a, 16.70%; C3b, 15.86%）. The incidence of C-shaped root canal diagnosed by radiographic method was statistically different from that by clinical examination and the combined examination （P〈O.05）. The study indicated a high incidence of C-shaped canal system in a Chinese population. The combination of microscopic and radiographic examination is an effective method in identifying the C-shaped root canal system.

Three-dimensional inlay-guided endodontics applied in variant root canals: A case report and review of literature

BACKGROUND Root canal retreatment is common after root canal therapy in clinical situations.Especially,completing the retreatment of variant root canals can be challenging.This is particularly true for the molars located at the end of the dental arch.However,advancements in digital dental diagnosis and treatment techniques can solve these problems.Here,we describe a case of a maxillary second molar with a variant distobuccal root canal treated via a novel“inlay-guided endodontics”technique based on improved computer-generated programs.CASE SUMMARY A 63-year-old man complained of a defect in the maxillary left second molar.The tooth,diagnosed with post-treatment endodontic disease,was initially treated by conventional methods,which were ineffective.Our“inlay-guided endodontics”technique was subsequently adopted,with the establishment of a precise integrated three-dimensional(3D)plate model of cone-beam computed tomography data and a digital impression of the dentition.An optimal root canal approach was generated for the“virtual file”in the 3D model.The plate data were imported into a 3D printer and printed.With the help of the guide plate,the file was accurately placed into the cervical third of the distal root canal.The root canal and prosthodontic treatments successfully proceeded subsequently.CONCLUSION Our newly developed inlay guide plates may facilitate individualized and minimally invasive root canal treatment.

ON THE NUMBER OF EULERIAN PLANAR MAPS

This paper presents the number of combinatorially distinct rooted Eulerian planar maps with the number of non-root-vertices and the number of non-root-faces as two parameters. The parametric expressions for determining the number in tha loopless Eulerian case are also obtained.

A comparison between radiovisiography and clearing technique in the study of the root canal types

Objective： To compare the radiovisiography （RVG） with the clearing technique using Kappa value in the study of the root canal types. Methods： One hundred recently extracted human maxillary first premolars were used. Standard periapical RVG images were taken from a buccolingual and mesiodistal direction. The specimens were then accessed, injected with ink, demineralized, dehydrated, and finally were cleared. The RVG images and the transparent teeth were examined by a trained endodontist, and the date of root canal types following Wu＇ s classification was collected. Results： The reliability of RVG was high for studies on simple root canals, but was poor for the studies on the multiple root canals. The Kappa value between the two techniques was 0.3793, indicating the agreement was poor. Conclusion： It is concluded that the limited value of RVG alone when studying certain aspect of the mot canal system. The resolution of the RVG system should be enhanced.

Application of apical negative pressure irrigation in the nonsurgical treatment of radicular cysts:A case report

BACKGROUND Radicular cysts are one of the most common odontogenic cystic lesions found in the jaw.Nonsurgical treatment of large radicular cysts is a topic of ongoing debate,and there is still no clear consensus on the most effective therapies.The apical negative pressure irrigation system aspirates the cystic fluid and releases the static pressure in the radicular cyst,representing a minimally invasive approach for decompression.In this case,the radicular cyst was in close proximity to the mandibular nerve canal.We used nonsurgical endodontic treatment with a homemade apical negative pressure irrigation system and the prognosis was good.CASE SUMMARY A 27-year-old male presented to our Department of General Dentistry with complaints of pain in the mandibular right molar when chewing.The patient had no history of drug allergies or systemic disease.A multidisciplinary management approach was designed and included root canal retreatment with a homemade apical negative pressure irrigation system,deep margin elevation and prosthodontic treatment.According to a 1-year follow-up period,the patient showed a favorable outcome.CONCLUSION This report reveals that nonsurgical treatment with an apical negative pressure irrigation system may provide new insights into the treatment of radicular cysts.

Different endodontic treatments induced root development of two nonvital immature teeth in the same patient:A case report

BACKGROUND Pulp revascularization is a novel way to treat immature teeth with periapical disease,and the technique has become increasingly well established in recent years.By puncturing the periapical tissue,bleeding is induced,and a blood clot is formed in the root canal.The blood clot acts as a natural bioscaffold onto which mesenchymal stem cells from periapical tissue can be seeded and restore pulp vascularity,thus promoting root development as well as apical closure.Although the effect of pulp revascularization is ideal,there are certain requirements for the apical condition of the teeth.The apical barrier technique and apexification are still indispensable for teeth that cannot achieve ideal blood clot formation.In addition,a meta-analysis of several clinical studies concluded that pulp revascu-larization has no significant advantages over other treatments.CASE SUMMARY A 10-year-old girl complained of pain in the right upper and lower posterior teeth for 2 d.Clinical and radiological examinations revealed that both the right maxillary and mandibular second premolars were immature with periapical radiolucency.The right maxillary second premolar was treated by pulp revascu-larization,while the right mandibular second premolar was treated by conven-tional apical barrier surgery after revascularization failed.The purpose of this report is to compare the different root maturation processes induced by the pulp revascularization and apical barrier techniques in the same patient in homonymous teeth from different jaws.Twelve months of follow-up showed that the apical foramen of both teeth presented a clear tendency to close;however,the tooth treated with pulp revascularization showed a significant increase in root length as well as root canal wall thickness.CONCLUSION For the treatment of nonvital immature teeth,pulp revascularization showed a superior therapeutic effect in comparison with the apical barrier technique.

Root Canal Treatment Outcome and Restorative Condition of Teeth Treated by Undergraduates—A Clinical and Radiographic Evaluation

Background: The aim was to evaluate the nonsurgical Root Canal Treatment (nRCT) outcome, the restorative condition and the relationship between the coronal restoration quality and the outcome of teeth endodontic treated by undergraduates at the University of Caxias do Sul School of Dentistry (UCS-SD), Brazil, between 2019 and 2021. Materials and Methods: Data from the endodontically treated cases were retrieved, and the patients were recalled for a follow-up appointment at the university. The endodontic diagnosis, radiographs, and the presence of definitive restorations were analyzed in the clinical records. During the follow-up appointment, endodontically treated teeth were classified as present or absent. The nRCT was classified as successful (complete or incomplete healing) or failure (uncertain or unsatisfactory healing). Coronal restoration was classified as absent or present. When it was present, it was classified as permanent or temporary, and its quality as adequate or inadequate restoration. The results were presented as percentages. Results: A total of 257 teeth were endodontically treated. The most prevalent diagnosis was Chronic Apical Periodontitis (33.33%) and the most commonly treated teeth were premolars (46.15%). A total of 52 (21%) treated teeth were clinically and radiographically reexamined. The success rate for the nRCT was 98.08%. About 61.54% of this sample had a definitive composite resin restoration. Conclusion: The nRCT success rate was high. Special attention should be given to the presence and quality of the definitive restoration. Clinical Implications: There was no statistically significant impact between the coronal restoration and the nRCT success (P > 0.05).

Non-surgical management of dens invaginatus type IIIB in maxillary lateral incisor with three root canals and 6-year follow-up:A case report and review of literature

BACKGROUND The presence of dens invaginatus(DI)complicates treatment of any tooth,from diagnosis to access cavity and biomechanical preparation and obturation.Reports of successful non-surgical management of DI type IIIB in maxillary lateral incisor are rare.Here,we report such a case,with three root canals and a long follow-up.CASE SUMMARY A 13-year-old female patient presented with mild pain in the maxillary right lateral incisor(#7)for 10-15 d.On examination,the tooth was slightly rotated,with slight tenderness on percussion and grade I mobility but with no caries,pockets or restorations and non-vital pulp(via vitality tests).Radiographic examination revealed unusual configuration of the tooth’s root canals,with an enamel-lined invagination extending to the apex,suggesting the possibility of DI Oehler’s type IIIB and a periapical radiolucency.Widening the access cavity lingually revealed one distinct buccal orifice and two distinct palatal orifices;under higher magnification of a dental operating microscope(DOM),the mesio palatal and disto-palatal orifices were observed as connected by a C-shaped groove.The root canals were prepared with hand K-files following a step-back technique,and obturated using a combination technique of lateral condensation and vertical compaction.At the 6-year follow-up,the patient was asymptomatic,and the periapical radiography displayed significant healing around the apical end of the root.CONCLUSION Proper knowledge of unusual root canal anatomy is required in treating DI.Conventional methods of root canal treatment can successfully resolve such complex cases,facilitated by DOM and cone-beam computed tomography.

Successful individualized endodontic treatment of severely curved root canals in a mandibular second molar:A case report

BACKGROUND The incidence rate of severely curved root canals in mandibular molars is low,and the root canal treatment of mandibular molars with this aberrant canal anatomy may be technically challenging.CASE SUMMARY A 26-year-old Chinese female patient presented with intermittent and occlusal pain in the left mandibular second molar.The patient had undergone filling restoration for caries before endodontic consultation.With the aid of cone beam computed tomography(CBCT),a large periapical radiolucency was observed,and curved root canals in a mandibular second molar were confirmed,depicting a severe and curved distolingual root.Nonsurgical treatments,including novel individualized preparation skills and techniques and the use of bioceramic materials as an apical barrier,were performed,and complete healing of the periapical lesion and a satisfactory effect were achieved.CONCLUSION A case of severely curved root canals in a mandibular second molar was successfully treated and are reported herein.The complex anatomy of the tooth and the postoperative effect were also evaluated via the three-dimensional reconstruction of CBCT images,which accurately identified the aberrant canal morphology.New devices and biomaterial applications combined with novel synthesis techniques can increase the success rate of intractable endodontic treatment.

Endodontic treatment of the maxillary first molar with palatal canal variations: A case report and review of literature

BACKGROUND Root canal variations frequently occur in maxillary first molars,which greatly affects the success of its treatment.The second mesiobuccal(MB)root canal is the most common root canal variation.However,only a few studies have been conducted on palatal root canal variations.Herein,we report the presence of two separate root canals in a palatal root of the maxillary first molar.CASE SUMMARY A 39-year-old woman complained of pain in the maxillary right region for 1 year,which recently worsened.Clinical examination revealed a poorly restored right maxillary first molar and caries detected at the filling marginal.Cold and heat test results indicated severe pain in the right maxillary first molar.The patient was diagnosed with irreversible pulpitis,and subsequently,root canal treatment(RCT)was performed.In total,five root canals were found in the maxillary first molar,including two separate root canals in the palatal root.RCT was successfully performed using an endodontic microscope and cone-beam computed tomography(CBCT).The CBCT image revealed a vertucci type I canal morphology in the distobuccal root,while the MB and palatal root canals were typeⅣ.At the 1-mo follow-up,the maxillary first molar was completely asy-mptomatic,and the X-ray results indicated a successful RCT.Finally,the ceramic crown restoration was performed.CONCLUSION An endodontic microscope and CBCT are useful in effectively identifying and treating root canal variations.

Formation and water environmental evolution of the Nansihu Lake

Through high-resolution research of sedimental chronology and the sediment environmental indexes, such as graininess, minerals, magnetic parameters, pigment content, organic carbon and chronology in Ds-core and Ws-core in Nansihu Lake, the authors analyze the formation cause of the Nansihu Lake and its water environmental changes. Historical documents are also analyzed here in order to reach the conclusion. Researches indicate that the Nansihu Lake came into being about 2500 aBP and its evolution succession can be divided into four stages. In this evolution process, several scattered lakes merge into one large lake in the east of China. This process is distinctively affected by the overflow of the Yellow River, the excavation of the Grand Canal and other human activities.

The Effect of Ultrasonic Method for Preparing Root Canals:A Scanning Electron Microscopic Evaluation

Sixteen fresh extracted human teeth paired according to their anatomic locations,were divided into two groups at random.The root canais of the teeth in Group 1 were preparedwith an ultrasonic unit and those of Group 2 with hand instruments.Then,the specimens wereobserved under a scanning electron microscope and their pnotographs were taken.Blindevaluation of cleanness was performed for each canal.Statistical dnalysis of the data indicatesthat the canal walls were cleaner in Group 1 than in Group 2 and that the ultrasonic preparationtook less time.

Small Modular Solutions to Fermat’s Last Theorem

The proof by Andrew Wiles of Fermat’s Last Theorem in 1995 resolved the existence question for non-trivial solutions in integers x,y,zto the equation xn+yn=znfor n>2. There are none. Surprisingly, there are infinitely many solutions if the problem is recast in terms of modular arithmetic. Over a hundred years ago Issai Schur was able to show that for any n there is always a sufficiently large prime p0such that for all primes p≥p0the congruence xn+yn≡zn(modp)has a non-trivial solution. Schur’s argument wasnon-constructive, and there is no systematic method available at present to construct specific examples for small primes. We offer a simple method for constructing all possible solutions to a large class of congruences of this type.

Clinical Treatment and Anatomy Study of Maxillary First Molars with Five Root Canals

THE purpose of root canal treatment is to thoroughly clean the root canal system and fill it in all its dimensions.I To achieve this goal, the entire root canal system must be adequately debrided and completely filled. In clinical practice, variations in the canal morphology pose a constant challenge to endodontists in deciding on accurate diagnosis and appropriate management. Knowledge of these variations is crucial for a successful endodontic treatment, especially in absence of an operating microscope or cone-beam computered tomography （CBCT）.

Radiographic study of the root canal system of mandibular incisors in Palestinian population

Aim: The aim of this study was to survey the root canal morphology of mandibular incisor teeth in a Palestinian population using radiographic approach. Materials and Methods: Five hundred and twenty two extracted mandibular incisor teeth were randomly collected from Palestinian population. The teeth were radiographed from a mesiodistal direction and examined for the presence of a second canal and for the type of canal configuration. Results: All teeth had single root. Three hundred and sixty nine teeth (70.7%) had one canal (type I Vertucci classification). The rest (29.3%) had a second canal (type II and III). Conclusion: Mandibular central and lateral teeth were mostly found to have one root and Type I canal system.

Comparison of Two Electronic Root Canal Length Measurement Devices: The Differences between Ratio Two Impedance Frequencies and Multi Frequencies

Accuracy electronic root canal length measurement devices were important for root canal treatment. Aim: To evaluate and compare accuracy of the two electronic root canal length measurement devices;two frequencies impedance ratio and multi frequencies. Methods: Forty anterior teeth were sectioned on their cervical area. All samples were measured root canal length by radiographic. On the second phase, all the samples were measured by two frequencies impedance ratio and multi frequencies electronic devices. In the final phase, the teeth were split vertically and actual lengths were measured. All measurement by radiographic and electronic method was subtracted with actual length. Statistical analysis was performed using Chi-square and the Kolmogorov-Smirnov test. Results: Accuracy of the two frequencies impedance ratio 50% and multi frequencies 47.5%. No statistical significance between two frequencies impedance ratio and multi frequencies. Conclusions: There is no difference between ratio two impedance frequencies and multi frequencies.