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    Dr. Shivani Bhatt

    “For everyone that asketh …..recieveth

    He that seeketh….. findeth

    To him that knocketh…. It shall be opened”

    The Bible



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    The above is one of the many articles that illustrate the importance of detection, cleaning, shaping and filling of middle mesial canals.

    I would like to share one of my failed cases because of missed middle mesial canal.

    Case treated by me comes with pain again after 2 years

    Chief  complaint:

    • Severe pain associated with root canal treated 46 in a 28 year old male patient

    On examination:

    • 46 with metal crown
    • No swelling
    • Very tender on percussion

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    Radiograph shows:

    • Root canal treated 46
    • Huge radiolucency associated with mesial root


    • Failed root canal with 46

    Treatment plan:

    • Re root canal with 46

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    • Removal of crown
    • Rubber dam isolation
    • Pre endo built up in composite
    • Removal of gp points by R-Endo by micromega
    • Search for middle mesial canal(mm)
    • Where and how to search for middle mesial canals;
    • Mm is present in the isthumus between the mesiobuccal and mesiolingual canals more towards the mesiolingual.
    • Troughing of the isthmus between mb and ml with
    • Scaler tip
    • Endo guide bur
    • Dg 16 probe
    • Magnification
    • Irrigation to remove the dentinal shavings

    At times the mm meets one of the two canals or both the canals at a point near or above the apex.

    Prepare only till that point to avoid weakening of tooth structure.

    Preparation of all canals with TF

    Apical diameter: mesials-30 distal-35

    Irrigation: 5% warm sodium hypochlorite MDA

    Calcium hydroxide dressing for 10 days

    Obturation: lateral condensation

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    DISCLAIMER : “Views expressed above are the author’s own.”

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