Key to success in endodontics (part 2)

Abstract

Plenty variants of the teeth endodontic structure requires a thorough study of the root canal anatomy and morphology peculiarities, which will make it possible to estimate the volume and complexity of future endodontic intervention, make a prediction of the treatment result, and forecast possible complications. For an objective assessment of the tooth root system anatomical and morphological features, the main method is x-ray examination. Endodontic treatment planning requires the doctor to estimate his capabilities (in difficult cases, it is necessary to refer the patient to a specialized clinic), calculate future working time (it takes more time to treat a tooth with complex anatomy), and to have all the necessary set of endodontic instruments. If endodontic treatment is impossible, then it’s necessary to consult with a dental surgeon to select a combined approach for treatment (root apex resection, root amputation, tooth hemisection). Purpose of the study. To analyze different variants of roots and root canals anatomical structure of the lower jaw teeth according to literature sources and by X-ray pictures of the authors’ own observations. Materials and research methods. Variants of the anatomical and morphological features of the lower jaw teeth’ roots and root canals structure were analyzed according to literature sources and 405 x-rays of our own observations. The results of the study. The information presented in this article allows to deepen the clinician knowledge concerning the tooth cavity size and shape, the roots and root canals anatomy, the presence of additional channels, as well as the degree of the root canal curvature, and to choose the right channel instrumentation technique and the necessary tools. Often, the proper full working length root canal treatment depends on the degree of curvature and its location. The X-ray analysis of anatomical and morphological features of the lower jaw teeth’ roots and root canals, enables us to identify both common and individual features of a tooth anatomy. When analyzing radiographs of the lower jaw teeth, it is necessary to take into account the projection of the tooth cavity on the outer surface of the crown, as well as signs that may change due to age, caries, non-carious lesions, restorations, and trauma; also anomalies of the position of the tooth in the arch, individual anatomy of the roots, the number of roots and type of root canals, the shape of their cross section (from the orifice to the apex), the direction and length of the roots, the angle of curvature, the number of bends, their localization. For the right choice of the root canal treatment technique and the necessary tools, it is important for the clinician to know the degree of bending of the root canal. Each case requires an individual and skilled approach. Therefore, to assess the possible structural features of the tooth root system, it’s efficiently to use the most modern tools, equipment, and X-ray tactics. The literature data and the analysis of our own radiographs allow us to solve successfully and predictably difficult clinical problems of both primary treatment and retreatment endodontic cases.