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Table of Contents
CASE REPORT
Year : 2020  |  Volume : 8  |  Issue : 4  |  Page : 109-111

Endodontic management of permanent mandibular second molar with Vertucci type II canal configuration: A rare case report


1 Department of Conservative and Endodontics, Bangalore Institute of Dental Sciences and Hospital, Bangalore, Karnataka, India
2 Private Practitioner, Bidar, Karnataka, India
3 Department of Oral and Maxillofacial Surgery, Rangadore Memorial Hospital, Bangalore, Karnataka, India
4 Department of Dentistry, All India Institute of Medical Sciences, Mangalagiri, Andra Pradesh, India

Date of Submission12-Nov-2020
Date of Acceptance17-Nov-2020
Date of Web Publication29-Dec-2020

Correspondence Address:
Dr. Subhashini Rajasekhara
Department of Conservative and Endodontics, Bangalore Institute of Dental Sciences and Hospital, No-4, Service Road, RPC Layout, Vijaynagar, Bangalore 560040, Karnataka.
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/INJO.INJO_49_20

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  Abstract 

The permanent mandibular second molars usually have two roots (mesial and distal), one mesial with two root canals (Mesiobuccal and Distobuccal) and another distal root, with one (distal)/two canals (Distobuccal and Distolingual). Multirooted posterior teeth more commonly show variations in root canal morphology. The present case report describes diagnosis and endodontic management of permanent mandibular left second molar having single root with Vertucci type II canal configuration.

Keywords: Endodontic therapy, mandibular second molar, root canal morphology, Vertucci type II configuration


How to cite this article:
Rajasekhara S, Nawabadkar S, Manjunath SA, Yerragudi N. Endodontic management of permanent mandibular second molar with Vertucci type II canal configuration: A rare case report. Int J Oral Care Res 2020;8:109-11

How to cite this URL:
Rajasekhara S, Nawabadkar S, Manjunath SA, Yerragudi N. Endodontic management of permanent mandibular second molar with Vertucci type II canal configuration: A rare case report. Int J Oral Care Res [serial online] 2020 [cited 2021 Jan 16];8:109-11. Available from: https://www.ijocr.org/text.asp?2020/8/4/109/305361




  Introduction Top


Our goal in endodontic therapy is to thoroughly clean, shape, and obturate the root canal system.[1] Lack of knowledge about the diversity of root canal morphology leads to failure in locating the canals and thus incomplete obturation by the clinician and leaving the canal untreated is often the culprit that results in endodontic failures.[2] Radiography imaging in endodontics serves at all stages from preoperative assessment of the case to final assessment of healing. In Endodontics, intraoral radiographs help us in identifying the number, pattern, and curvature of the root canals. Proper radiographic imaging techniques and correct interpretation are essential for sound diagnosis and treatment planning.[3]

Human permanent molars show significant anatomic variation and abnormalities with respect to the number of roots and root canals.[4] Variations in anatomy with the mandibular molars have been investigated in several studies and reported in literature. According to Vertucci, the mandibular second molar is similar to the first molar in anatomy, except that the roots are shorter, the canals are more curved, and the extent and range of variations are broader.[5] Previous studies on the root canal anatomy of mandibular second molars with one canal in a single conical root have been reported.[6],[7] But, there is only one case report reported in the literature similar to the present case.[8]

The aim of this paper was to report endodontic management of mandibular second molar having a single root with Vertucci type II canal configuration.


  Case Report Top


A 22-year-old female patient reported to our hospital with a chief complaint of constant pain in the lower left back tooth region of 1-week duration. Medical history was noncontributory. Clinical intraoral examination revealed the presence of deep carious lesion irt to tooth number 37, moderately deep caries irt to tooth number 36. Percussion testing showed tenderness to percussion with respect to first and second molar. Thermal and electric pulp testing (Gentle pulse analog P.V. tester, Parkell Prod. Inc.) Elicited a delayed response irt tooth number 36 and negative response irt tooth number 37. Radiographic examination of tooth number 36 revealed coronal radiolucency approximating the pulp and Periapical structure appeared to be within normal limits and irt tooth number 37 showed coronal radiolucency involving the pulp with a widening of apical periodontal ligament space and tracing the lamina dura and PDL space demonstrated unusual anatomy of single conical root and in the middle third of the root canal space showed a division of radiolucent canal indicating the presence of second canal [Figure 1]A. Based on the clinical and radiographic findings tooth number 36 was diagnosed as irreversible pulpitis and tooth number 37 was diagnosed as pulpal necrosis with acute apical periodontitis. Root canal treatment was advised for both the teeth irt tooth number 36 and 37.
Figure 1: (A) Intraoral peri-apical, pre-operative diagnostic radiograph showing permanent mandibular left second molar with complex root anatomy. (B) Working length determination. (C) Master cone selection. (D) Post-obturation radiograph

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To describe the Root canal configuration Vertucci’s classification is used as a reference.[5] In the present case, we detected Vertucci type II canal configuration. Which means two separate canals leaving the chamber, but merging short of the root apex (2-1 configuration).

Local anesthesia was administered and rubber dam was applied. Endodontic access cavity was prepared on the occlusal surface of the tooth number 37 using a no 2 endoaccess bur (Dentsply). Pulp chamber was encountered and necrotic pulp tissue was extirpated using barbed broach and ISO 10 K- files. The canal was thoroughly débrided with copious irrigation of sodium hypochlorite (2.5%) and saline (0.9%) to ensure complete removal of the necrotic pulp tissue. On careful inspection of the pulp chamber, two distinct canal orifices (Mesial, Distal) were observed [Figure 2]. Coronal flaring of the two canals was performed with Gates Glidden drills (GG drills). Initial negotiation of the root canals was performed with k-files ISO 10. Working length determination was performed radiographically with size 10 files in Mesial and distal canals [Figure 1B]. Interpretation of radiographs revealed the presence of type II canal configuration. Biomechanical preparation was done using the crown down technique using NiTi rotary protaper files (Protaper™, Dentsply).
Figure 2: Access opening

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The sequence of instrumentation was SX file, shaping file no 1(S1), shaping file no 2(S2), finishing file no 1(F1), finishing file no 2(F2). Apical preparation was performed till finishing file no 2(F2). Irrigation was performed with 2ml of sodium hypochlorite 2.5% after each file size.RC prep was used as a chelating agent with each instrument. A final flush with 3ml of 2% chlorhexidine was also performed. Calcium hydroxide mixed with 2% CHX was used as an interappointment medicament and remained within the roots canal systems with cavit as coronal access filling for 10 days. The patient returned after 10 days for completion of the treatment. The tooth was asymptomatic and isolation and access were made without anesthesia. Instrumentation was repeated with protaper rotary files and the canals were thoroughly rinsed with 2.5% sodium hypochlorite. Final irrigation was done using 17% EDTA. Root canals were dried with sterile paper points. Master cone selection was done [Figure 1C] and root canals were obturated with protaper universal gutta-percha points (Protaper Gutta Percha™, Dentsply) of the same size as the last protaper file used and ZOE sealer [Figure 1D]. Since the Coronal tooth structure destruction was an extensive definitive restoration of fiber post and composite core build-up was done and the restoration was completed by placing metal-ceramic crown irt to tooth # 37.


  Discussion Top


The morphological variation in the root canal anatomy can be analyzed preoperatively by studying the angled periapical preoperative radiographs thoroughly. In this case also preoperative radiograph itself revealed variation in the root canal anatomy of single-rooted left mandibular second molar with Vertucci type II canal configuration. However, all variations cannot be assessed with two-dimensional periapical radiographs. When we fail to obtain additional and conclusive information from them, CBCT should be considered.[9]

According to a study done by Prasanna Neelakantan et al. most common morphology in Indian Mandibular Second Molars was the two-rooted teeth (mesial and distal) with three canals (two mesial and one distal) and the study also concluded that c-shaped canals are found in 7.5% of the teeth most of which had single canals.[10] Manning et al. in his study reported 76% of mandibular second molar shows two roots, 22% had single root and only 2% had three roots and very often (64%)of the mesial root has two canals the there is almost always only one independent canal (92%) in the distal root. He also reported higher frequency of single-rooted and C-shaped mandibular second molars in Asians.[11] In a study done by Ajinkya et al., most common configuration was two-root (79.35%) and three-root canals (53.50%). The incidence of three-rooted molars was 7.53%, whereas 13.12% of the studied teeth have fused roots with C-shaped canals.[12]


  Conclusion Top


Successful endodontic therapy involves complete pulp extirpation followed by a three-dimensional seal of the root canal space. Endodontic diagnosis is the starting point for achieving successful treatment. Radiographs serve as a valuable diagnostic aid in studying the root canal morphology of human teeth. Also, the clinician’s knowledge about the diversity of root canal morphology in locating the canals plays a very crucial role to perform successful endodontic therapy. In this present case, 2D radiograph helped us to diagnose and manage the case. But sometimes, all variations cannot be assessed with two-dimensional periapical radiographs. When we fail to obtain additional and conclusive information from them, CBCT should be considered.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Siqueira JF Jr. Aetiology of root canal treatment failure: Why well-treated teeth can fail. Int Endod J 2001;34:1-10.  Back to cited text no. 1
    
2.
Tabassum S, Khan FR Failure of endodontic treatment: The usual suspects. Eur J Dent 2016;10:144-7.  Back to cited text no. 2
    
3.
Zhang R, Yang H, Yu X, et al. Use of CBCT to identify the morphology of maxillary permanent molar teeth in a Chinese subpopulation. Int Endodon J2011;44:162-9.  Back to cited text no. 3
    
4.
Alaçam T, Tinaz AC, Genç O, Kayaoglu G Second mesiobuccal canal detection in maxillary first molars using microscopy and ultrasonics. Aust Endod J 2008;34:106-9.  Back to cited text no. 4
    
5.
Vertucci FJ Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol 1984;58:589-99.  Back to cited text no. 5
    
6.
Roy A, Velmurugan N, Suresh N Mandibular second molar with a single root and a single canal: Case series. J Clin Diagn Res 2013;7:2637-8.  Back to cited text no. 6
    
7.
A Alfadley, A Alquraishi, Y Almazrou, F Aljarbou. A rare case of single-rooted mandibular second molar with single canal. Case Reports Dentistry2020;June:1-6.  Back to cited text no. 7
    
8.
Nagaveni NB, M Bajaj, S Yadav, Poornima P Endodontic management of mandibular second molar with Vertucci II canal configuration using cone beam computed tomography. Dental Res Manag2017;2:104-7.  Back to cited text no. 8
    
9.
Patel S, Brown J, Pimentel T, Kelly RD, Abella F, Durack C Cone beam computed tomography in endodontics – a review of the literature. Int Endod J 2019a;52:1138-52.  Back to cited text no. 9
    
10.
Neelakantan P, Subbarao C, Subbarao CV, Ravindranath M Root and canal morphology of mandibular second molars in an Indian population. J Endod 2010;36:1319-22.  Back to cited text no. 10
    
11.
Manning SA Root canal anatomy of mandibular second molars. Part II. C-shaped canals. Int Endod J 1990;23:40-5.  Back to cited text no. 11
    
12.
Pawar AM, Pawar M, Kfir A, Singh S, Salve P, Thakur B, et al. Root canal morphology and variations in mandibular second molar teeth of an Indian population: An in vivo cone-beam computed tomography analysis. Clin Oral Investig 2017;21: 2801-9.  Back to cited text no. 12
    


    Figures

  [Figure 1], [Figure 2]



 

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