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138 rev port estomatol med dent cir maxilofac. 2019;60(3):137-144

Tratamento endodôntico de primeiro molar inferior com três canais
radiculares distais – série de casos

r e s u m o

Palavras-chave: O primeiro molar inferior pode apresentar várias configurações anatómicas, sendo a mais
Anatomia prevalente a presença de duas raízes com três canais radiculares. Apesar da incidência de
Endodontia três canais radiculares na raiz distal ser baixa, deve ser tida em consideração. Neste trabalho
Molar apresentamos o relato de dois casos clínicos de retratamento endodôntico não cirúrgico e
Morfologia um caso de tratamento endodôntico não cirúrgico de primeiros molares inferiores com três
Tratamento endodôntico canais radiculares distais. Uma análise meticulosa do pavimento da câmara pulpar, com o
auxílio do microscópio ótico, revelou a existência de canais inesperados. Canais radiculares
não detetados durante os procedimentos endodônticos são uma das possíveis causas do
fracasso do tratamento endodôntico. Uma má avaliação e interpretação da anatomia inter-
na de um dente submetido a tratamento endodôntico pode levar a uma desinfeção e instru-
mentação deficitárias, pondo em risco o sucesso da terapia. (Rev Port Estomatol Med Dent
Cir Maxilofac. 2019;60(3):137-144)
© 2019 Sociedade Portuguesa de Estomatologia e Medicina Dentária.
Published by SPEMD. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

All the teeth were anesthetized with a mandibular block
Introduction
infiltration using 1.8 ml of 4% articaine with 1:200,000 epineph-
The main goal of root canal therapy is to perform mechanical rine (Artinibsa, Inibsa, Spain), and rubber dam isolation was
debridement and chemical disinfection of the root canal established. A proper access cavity was obtained, and the pulp
space, followed by root canal filling, which will ensure a good chamber floor anatomy was inspected through a dental oper-
1
long -term prognosis of the treatment. To achieve this objec- ating microscope (Opmi Pico, Carl Zeiss Surgical, Germany).
tive, a good understanding of the root canal anatomy is man- After being identified, all the root canal orifices were negoti-
datory. ated until the working length with a stainless -steel ISO size.10
The mandibular first molar anatomy has been the subject hand file (Dentsply Maillefer, Switzerland). In the retreatment
of several studies. 2,3,4 The most common anatomical configu- cases, Eucalyptol was used as a solvent. The working length
2
ration of this tooth is two roots and three root canals. Howev- was determined with an electronic apex locator (Root Zx II,
er, several other morphologies have been reported. Variations Morita, USA) and confirmed radiographically. A manual glide
of the number of roots include radix paramolaris, radix entomo- path was performed with stainless steel ISO size.15 hand files
5
laris and root fusion. The number of root canals may vary both (Dentsply Maillefer, Switzerland). The mechanical instrumen-
2
in number and configuration. An uncommon root canal con- tation was performed in all cases with NiTi rotary files ProTa-
figuration is the presence of three root canals in the distal root per Universal (Dentsply Maillefer, Switzerland), following the
of the mandibular first molar. This clinical condition has been instructions of the manufacturer. All instrumentation was
documented in very few case reports and may present a prev- performed under continuous and abundant syringe irrigation
6,7
7
alence as low as 0.2%. The misinterpretation of the individual with 5.25% sodium hypochlorite at room temperature, with a
tooth morphology may lead to treatment failure. 8 side -vented Monoject 27G needle (Covidien, Mansfield, USA).
The purpose of this work is to present three cases of end- All treatments required two appointments. A calcium hy-
odontic treatment of mandibular first molars with three root droxide dressing (Ultracal, Ultradent, USA) was used between
canals in the distal root. appointments, and Cavit (Cavit W, 3M ESPE, Germany) was
used as a provisional restoration.
In the second visit, a final irrigation protocol, which includ-
Case reports ed rinses with 17% EDTA, 5.25% sodium hypochlorite and al-
cohol, was performed. The canals were dried with paper
General clinical procedures points, and root canal filling was completed with Zipperer
The reported cases were referred for treatment in private gutta -percha cones (VDW, Munich, Germany) and sealer (AH
clinics in the area of Lisbon. After clinical evaluation, a diag- Plus, Dentsply, Germany), using the continuous wave of con-
nosis was established, the condition was explained to the densation technique. The downpack was accomplished with
patients and the treatment options were proposed. The pa- a System B unit (System B, Sybron Endo, USA) and the backfill
tients signed an informed consent form before initiating the with an Obtura II unit (Obtura II, Obtura Spartan, USA). After
treatment. canal obturation, the pulp chambers were cleaned with alco-