Root Canals in Primary and Permanent Bicuspids: Special Considerations

The presence of accessory roots in the primary dentition is rare, and comprehensive knowledge of dental anatomy is essential for successful treatment. When a primary tooth persists and its permanent successor is absent, the dentist may face several obstacles. This article discusses the treatment of a root canal in a second primary maxillary molar with four roots, a rare occurrence. Most dentists are qualified to perform root canals, but in certain cases, the dentist may refer you to an endodontist.

Endodontists specialize in the treatment and repair of pulp and other complex dental problems. Their goal is to save the natural tooth and restore a painless smile. Internal inflammatory root resorption is a particular category of pulp disease that can be diagnosed through clinical and radiographic examination. As growth progresses, the root canal is narrowed by the continuous deposition of dentin and the pulp tissue is compressed.

The permanent tooth bud is located lingually and apically with respect to the primary anterior tooth, so physiological root resorption of primary incisors and canines begins on the lingual side of the apical third of the roots. Current x-rays are essential for detecting tooth decay, restoration integrity, previous endodontic treatments, and periapical and resorptive changes in primary and young permanent teeth. A retained primary tooth that is properly occluded with its counterpart and that has a satisfactory state of crown and roots with solid periodontal integrity can function for several years. Indirect pulp treatment (IPT) in primary dentition is considered a contemporary and effective approach for treating a deep carious lesion in the absence of signs or symptoms of irreversible pulp pathosis.

In teeth with multiple roots or with multiple canals, the probability that the canals will be lost is especially high in cases where there is aberrant root morphology and internal anatomy. Pathological changes in the periapical tissues surrounding primary molars are usually evident in bifurcation or trifurcation areas rather than in the apices. Fusion of the palatine and dystofacial roots occurs in approximately one third of first primary maxillary molars. Incomplete debridement of the root canal system is the most common cause of endodontic treatment failure.

Formaldehyde, a volatile organic compound, is toxic and corrosive, especially at the point of contact. While root canals have a bad reputation, you may find that the infection itself was much worse than the treatment. Bleeding is controlled with slightly moistened cotton granules (moistened and dried almost dry) that are placed against the pulp stumps in the openings of the root canals.

Eloise Cuttitta
Eloise Cuttitta

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