Middle mesial canals.

Dr. Shivani Bhatt

“For everyone that asketh …..recieveth

He that seeketh….. findeth

To him that knocketh…. It shall be opened”

The Bible

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

Radiograph shows:

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

Diagnosis:

• Failed root canal with 46

Treatment plan:

• Re root canal with 46

Treatment

• 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

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