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MANDIBUL

AR
2 PRE
BY
O.R.GANESH
MURTHI
M.Sc.D ENDO
OUT LINE
q INTRODUCTION
q EXTERNAL ANATOMY
q INTERNAL ANATOMY
q VARIATIONS
q ANOMALIES
q ENDODONTIC
CORRELATION
INTRODUCTION
§ The term premolar is used to
designate any tooth in the permanent

dentition that replaces a primary


molar.
§ fifthtooth from midline in the
mandible quadrant.
§ They assist canine in shearing and
support corners of the mouth from
Mandibular 2nd premolar

Average time of eruption : 11 to 12


years

Average age of calcification : 13 to 14


years

Average length : 22.3 mm


Significance of average time of eruption,age of
calcification,tooth length & root curvature:

IT HELPS IN DIAGNOSIS AND TREATMENT PLAN

TREATMENT IS DIFFERENT IN ADULT AND YOUNG

NECROTIC PULP
ADULT RCT
IRREVERSIBLE
PULPITIS
YOUNG

Irreversible Pulpit's
Reversible Pulpit's Necrotic Pulp

Pulp Capping or Closed Apex Open Apex


Pulpotomy

Apexogenesis RCT Apexification


Obturation
Mandibular 2nd premolar

Average Length : 21.4


mm

Maximum Length : 23.7


mm

Minimum Length : 19.1


mm
Mandibular 2nd premolar
IMPORTANCE
It helps in the
determining the working length and
better assumption of the radiograph

Consideration must be given to the


mental foramen which lies in close
proximity to the apex. Avoid over
instrumentation and overfill.
Mandibular 2nd premolar
Buccal aspect

Long pointed buccal cusp in


the occlusal profile

Mesial cusp ridge is shorter


than distal

Cusp tip is a little mesial to


the tooth midline
Mandibular 2nd premolar
Buccal aspect

Mesial & Distal outlines


are markedly converging

Cervical line is flat


mesiodistal compared to
that of canine

Root is conical with


pointed apex
Mandibular 2nd premolar
Lingual aspect

mesiodistal diameter = that


from Buccal aspect

Occlusal surface cannot be


seen fully

Occlusal plane is
perpendicular to tooth Axis
Mandibular 2nd premolar
2 lingual cusps (most
commonly)
2/
3

• Mesiolingual – major,
2/3 MD diameter,
same height as Buccal

• Distolingual – minor

Lingual groove
Mandibular 2nd premolar

Mesial aspect
Triangular ridges of Buccal

and Mesio lingual cusps


don’t not form a
continuous crest

Distal aspect
Both lingual cusps are
Mandibular 2nd premolar
Occlusal aspect
Square profile
Mesial & Lingual profiles are
parallel
More than half of Buccal
surface is visible
Buccal ridge is less prominent
than that of mandibular 1st
premolar
Mesial & Distal Marginal
ridges are equal in length
Mandibular 2nd premolar

Occlusal view
M
Mesial & Distal D

triangular fossae
each contains
• A pit
• Mesiobuccal &
Distobuccal grooves
Mandibular 2nd premolar
Occlusal view
Grooves (Y shape meet at the
central pit)
• Mesial groove separates
Buccal & Mesiolingual triangular
ridges – runs obliquely
• Lingual groove separates B

lingual cusps D
M
L
• Distal groove separates L

Buccal & Distolingual triangular


ridges
Mandibular 2nd premolar
Pulp
Buccolingual
section
• Pulp chamber is
wider
• Pulp horns are of
equal height
Mandibular 2nd premolar
PULP CHAMBER

v Mesiodistal width - narrow


v Buccolingual width - wide
v Lingual horn is more prominent
under a well developed lingual

cusp
v 30 lingual tilt
v Cross section – ovoid with greater
Mandibular 2nd premolar
Mandibular 2nd premolar
ROOTS AND ROOT CANALS

The Mandibular second premolar


resembles the first premolar, but the
lingual canal is present only
occasionally.

The root canal is oval in cross-


section and rather straight with only
a slight distal curvature in some
canals
Mandibular 2nd premolar
Mandibular 2nd premolar
ROOTS AND ROOT CANALS
Mandibular 2nd premolar
ROOTS AND ROOT CANALS
1 Canal 1 foramen - 85.5 %
1 canal 2 foramen - 11.5 %
2 Canal 1 foramen - 1.5 %
3 canal - 0.5 %

Distal curve – 40 %
Straight – 39 %
Buccal curve – 11 %
Lingual curve – 10 %
ROOTS AND ROOT CANALS

One root canal Single canal that


dividing in has divided and
to two at apex cross over at the
apex
ROOT CANAL ORIFICES 1 CANAL
SEPARATE IN
TO 2 CANALS

DIVISION IS
BUCCAL
AND LINGUAL

LINGUAL CANAL
SPLITS
FROM THE MAIN
CANAL
AT SHARP ANGLE IT
IS
VISUAL

BUCCAL CANAL IS
STRAIGHT
ACCESSORY CANALS
Mostly found in the
apical third Lateral
canals may be found in
44.3% cases Usually a
good biomechanics
preparation cleanses
the canal well and is
filled with the sealer
during Obturation.
The ability to cleanse
and seal these canals
have an impact on the
prognosis
Mandibular 2nd premolar
Note :

• When only one canal is present , it


is usually found in the center of the
access preparation.
•If only one canal is found, but it is
not in the centre of the tooth, it is
probable that another canal is present
ROOT CANAL ORIFICES
1 CANAL
PRESENT
LOCATED IN THE NOT LOCATED IN
CENTER CENTER
OF THE ACCESS OF THE ROOT
PERPARATION

ANOTHER ORIFICES
PROBELY
EXISTS

CLINICIAN SHOULD
SEARECH
FOR OPPOSITE SITE
Mandibular 2nd premolar

Anatomic relationships in situ

The mental canal and foramen are


close to the root apex Radiograph
appearance may shows peiapical
pathosis Closely related to the outer
and inner alveolar plate These plate
consist of thick layer of compact
bone
Anatomic relationships in situ

Avoid over instrumentation and


overfill When viewing an x-ray of this
area, the mental foramen is
sometimes misdiagnosed as a
premolar abscess. Therefore, before
performing root canal therapy, make
sure all diagnostic tests confirm your
finding.
FAST BREAK
When numerous
canal are present,
the preoperative
radiograph often
indicates a "fast
break." This appears
as a relatively patent
canal space in the
coronal portion of the
tooth that suddenly
disappears.
FAST BREAK

Note:

If a straight-on preoperative
radiograph of a Mandibular 2
premolar shows the pulp canal
disappearing in mid-root, this is
an important indication that two
canals are present.
Mandibular 2nd premolar
The mandibular second premolar is
similar to the first premolar, with the
following differences:

Ø The lingual pulp horn usually is


larger

Ø The root and root canal are more

often oval than round

Ø The pulp chamber is wider


THE ACCESS CAVITY
The access cavity form for the Mandibular
second premolar varies in at least two
ways in its external anatomy.

1.The crown typically has a smaller


lingual inclination less extension up the
buccal cusp incline is required to achieve
straight-line access.

2. The lingual half of the tooth is more


fully developed; therefore the lingual
access extension is typically halfway up
the lingual cusp incline.
THE ACCESS CAVITY
The Mandibular second premolar can
have two lingual cusps, sometimes of
equal size. When this occurs, the access
preparation is centered mesiodistally on
a line connecting the buccal cusp and
the lingual groove between the lingual
cusp tips.
When the mesiolingual cusp is larger
than the distolingual cusp, the lingual
extension of the oval outline form is just
distal to the tip of the mesiolingual
cusp.
THE ACCESS CAVITY

Buccolingual ovoid outline form reflects the


anatomy of the pulp chamber and position
of the centrally located canal.
THE ACCESS CAVITY
• The lingual portion should be
prepared well for a straight line
access and location of lingual canal.
CROSS SECTIONAL IN CERVICAL LEVEL

the pulp is large in


a young
tooth, very wide in
the Buccolingual
dimension.
Debridement of the
chamber is
completed during
coronal cavity
preparation with a
round bur
CROSS SECTIONAL IN MIDROOT

Midroot level: the canal


continues to be long ovoid
and requires perimeter
filing
Apical third level: the
canals, generally round,
are shaped into round,
tapered preparations.
Preparation terminates at
the cementodentinal
junction, 0.5 to 1.0 mm
from the radiographic
apex.
MANDIBULAR 2 PREMOLAR TEETH
ERRORS IN CAVITY PREPARATION

PERFORATION

at the disto gingival


caused by failure to
recognize that the
premolar has tilted to
the distal
MANDIBULAR 2 PREMOLAR TEETH
ERRORS IN CAVITY PREPARATION

INCOMPLETE

preparation and possible


instrument breakage
caused by total loss of
instrument control.
Use only occlusal access,
never buccal or
proximal access.
MANDIBULAR 2 PREMOLAR TEETH
ERRORS IN CAVITY PREPARATION

BIFURCATION

Of a canal
completely missed,
caused by failure to
adequately explore
the canal with a
curved instrument
MANDIBULAR 2 PREMOLAR TEETH
ERRORS IN CAVITY PREPARATION

APICAL PERFORATION

Of an invitingly straight
conical canal. Failure to
establish the exact
length of the tooth leads
to trephination of the
foramen
MANDIBULAR 2 PREMOLAR TEETH
ERRORS IN CAVITY PREPARATION

PERFORATION

at the apical curvature


caused by failure to
recognize, by exploration,
buccal curvature.
A standard bucco lingual
radiograph will not
show buccal or lingual
curvature
Mandibular 2nd premolar
Anomalies
Ø Dens invaginatus

Ø Dens evaginatus

Ø Gemination

Ø Dilaceration
DENS INVAGINATUS
v Dens invaginatus is a malformation
of teeth probably resulting from an
infolding of the dental papilla during
tooth development.
v Affected teeth show a deep infolding
of enamel and dentine.
v Occurs before calcification of the
teeth.
v Also known as dens in dente
TREATMENT OF DENS
INVAGINATUS
• The treatment modalities depend on
the degree of complexity of its
anatomy.
• They include nonsurgical endodontic
treatment, endodontic surgery and
extraction.
• In cases in which there is an
immature apex, calcium hydroxide is
used to stimulate apexification
Endodontic treatment of dens
invaginatus type can become
complicated because of an
unpredictable internal anatomy.

The invagination and rudimentary


canals should be eliminated completely
to obtain a smooth wide canal.

A complete disinfection of the canal is


of great importance to promote healing
of affected periradicular tissues.
DENS
• Dens evaginatus is a
developmental anomaly that
manifests as a tubercle
emerging from the surface of
the affected tooth.
• It occurs most frequently in the
premolars.
• Higher prevalence among people
of Mongoloid origin.
DENS
EVAGINATUS
Clinical importance
• Fracture or wear of the tubercle
could lead to pulp necrosis before
root formation is complete.
• Various prophylactic treatments like
selective grinding, application of
resin, restorations and partial
Pulpotomy can be done.
• If there is complete pulpal necrosis in
an immature tooth, MTA can be used
in the apex followed by endodontic
treatment.
Mandibular second
premolar with
three root canals
Report of a case
A 20- year-old male with non
contributory medical history was
referred to the clinics of the SaudiBoard
in Advanced Restorative at the Faculty
of Dentistry, for evaluation of root canal
therapy of a mandibular 2 premolar.

Clinical examination revealed


that the tooth responded positively to
percussion but not to palpation.

Radiographic examination revealed


short and inadequate root canal filling
Pre-operative radiograph showing
the poor root canal filling.
The tooth was isolated with rubber
dam, the old amalgam filling was
removed and the access cavity
preparation was established.
The gutta-percha was removed
using Hedstroem file size 15.
Three canals were located,
buccally, lingually and an extra canal
in the middle.
The working length was checked
radiographically
Working length radiograph showing
files in the three root canals.
The canals were conventionally instrumented
to a # 35K file using crown-down
pressureless technique, irrigated with 5.25
percent sodium hypochlorite, dried with
sterile paper points and sealed with calcium
hydroxide paste The access opening was
closed with Cavit.
The patient returned asymptomatic after 1
week, the tooth was isolated with rubber
dam; the canals were instrumented with file
#35 and irrigated with sodium hypochlorite
to remove all the remnants of the calcium
hydroxide, and then dried with paper
points
Master cone was selected and the
canals were filled with gutta-percha
and AH26 sealer cement using
lateral condensation.

Access opening was sealed with


amalgam restoration. Post-operative
radiograph was taken to confirm
the quality of the filling .The patient
was referred to the prosthetic clinic
for crown construction.
Obturation of the three root canals
A shift angle radiograph of the
obturated canals.
DISCUSS
ION
Location and thorough instrumentation
of all the canals in the root of a diseased
tooth normally ensure success of the
endodontic therapy.
Presented is a case of mandibular
second premolar which was referred for
endodontic therapy. Clinical and
radiographic examination revealed
inadequate root canal filling. Three
canals were located. Endodontic therapy
was performed under aseptic
conditions
References
v Endodontics 5th Edition - Ingle & Bakland
v Pathways Of The Pulp 6th Edition - Cohen
v Endodontic Practice 11th Edition
Grossman
v A Textbook Of Oral Pathology - Shafer
v Wheeler’s Dental Anatomy, Physiology
and Occlusion 7th Edition – Ash
v Colors Atlas of Endodontics- William T.
Johnson
v Medical principles and practice
THANK YOU ALL