Occult Canals.

Dentistry January 25th, 2007

March 2006This patient was sent to me after a pulpectomy had been done. His dentist didn’t want to finish the endo because he couldn’t get intracanal bleeding to stop. That’s the duplicate film that was taken prior to the pulpectomy that was sent from the office . They also sent one working film that wasn’t of any diagnostic quality. Looks like a fairly straight forward case here.

October 2006So I did the endo and took that xray. Hmm. You can see a hint of an extra root that’s visible on the distal. That’s one of the problems with not taking working films. Looking back at the preop film, it’s there too, just not as obvious. The endo was done in October, the preop is from March. You can see that the lesion has increased significantly in size over this time.

January 2007This xray is from this month. Here’s what I did:

I wasn’t sure if I’d be able to locate this extra root or canal if I went back into the tooth because I didn’t see it at all when I was already in the tooth. So I had the patient’s dentist replace my temporary filling with a resin and leave some cotton in the chamber. I wanted to see how the tooth would respond to the treatment that I had already rendered prior to going back in. This would give me some idea of the actual value of locating the extra canal and also if I might need to discuss apical surgery.

Turns out that apical healing progressed quite rapidly over the three month period, leaving the need to locate the occult canal negligible. I went back in and using the buccal object rule with an interim film I determined that the canal was more lingual. After troughing around the pulp chamber for a while I still couldn’t locate any extra canal orifices so I went into the DL canal and found a branch mid-way down. I had to deal with the branch tactilly because I couldn’t see it (it was too deep and sharply divergent from the main canal). I managed to minimally instrument the canal with hand files, shoved a ton of sealer into it and then reobturated the main canal. I wasn’t able to get any significant amount of gutta-percha into the extra canal because of its location and direction.

By the way, the bleeding that his dentist wasn’t able to manage was because he hadn’t instrumented large enough. There was still hyperemic apical pulp. The patient is a teenager and obviously has wider canals because of this.


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  • Dr. Mommy, D.D.S.

    that’s wild. something like that happened with a 46 that treated when i was practicing in new york, my pre-op film looked like a pretty straightfoward 3 canal case. so i instrumented, took my working length radiographs, and whoa, another distal root, completely obstructed in my film. i found the orifice to the canal, very tightly squeezed next to the orifice the (now) DL canal. you know, even with apex locators, i still take working length films because you never know what you’re going to find at a different angle.

    what size file were you able to instrument that canal to? what kind of sealer did you use?

  • Ameloblast

    Yeah, this was a fifth canal. I had already found 4, so that’s something you don’t normally look around for. I stopped taking working films for the vast majority of my cases years ago. I have rationale for that, but that’s for another post…

    The occult canal was instrumented aggressively with a #20 only. I was concerned about transporting the canal with larger files. I use Roth sealer (a ZOE sealer) for all of my cases. There’s no good evidence that any other sealer increases prognosis. But again, that’s a topic for another post.

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