Aftina Mutiara | Keri Pangesti Y.

H
 Introduction
To clear
Increases the
Purpose pathogenic
microbes and
Root canal
difficulty of
variations
of RCT infected pulp in RCT
the root canal
single canal
97,90% :

1,8% : two
canals

The anatomical variations in the root

canal system of the mandibular first
premolar

than three canals

< 0,1% : more
canals
0,2% : three
 CASE REPORT

●
A 25 years old male was reported admitted to
Subjective the hospital due to intermitten pain in relation
to the lower right posterior teeth over 3 weeks.

●
Clinical examination found acceptable oral hygiene and deep distant proximal and occlusal caries penetrating the pulp
chamber on tooth #44. Compared to the same tooth on the opposite side , tooth #44 showed slight knocking pain,
sensitivity on the electric pulp tes and positive reponse to a heat test with a tooth glue stick.

Objective
●
There was no evidence of swelling or sinus tract on the alveolar mucosa.
●
The radiography examination showed that tooth #44 had distant proximal and occlusal carries penetrating the pulp
chamber. The periodontal ligament was found to be slightly widened. There was no apical radiolucency in association
of tooth #44. X-Ray showed the branch canals were in the lower third of the root canal.
●
Four canal were found under a dental operating microscope
●
The fifth canal was found later, during root cleaning and shaping
 Symptoma
Assesm tic pulpitis
ent in tooth
#44
Treatme Root Canal
nt Therapy
Planning (RCT)

Give the Local
anesthesia
Put the rubberdam
injection isolation
The #8 and #10 k-file
were used to dredge
the position that was
3 mm less than the
initial working length.
The orifices of the root canals
were trimmed using ET18D
under a dental operating
microscope unti the Straight
paths were established.
Clinical Step (First Appointment)
built the teeth wall
Remove the caries by composite resin
restoration
By using operating dental microscope, four root canals was found
The initial working (mesiobuccal, distobuccal-1, distobuccal-2, distolingual).
length of the root The orifices of the mesiobuccal, distobuccal-1 and distobuccal-2
determined by root canals were located at same level.
diagnostic X-ray and an
apex locator The distolingual root canal was located on the distal wall of tooth ,
2 mm above the level of the other canals, approximately 1 mm
away from distobuccal-1 root in the buccal direction.
After preparation, an ultrasound After root canal dessication,
An Mtwo rotary was used for calcium hydroxide was filled in
systemn was used to activate
root canal preparation. The
lower section was prepared to a
sodium hypochlorite 2% and 15% and put the temporary sealer
EDTA solution for 1 minute in the by zinc oxide (Ceivitron,
#25/0.06 taper.
root canal. Dongquan, Taibei)
 Second Appointment (2 weeks later)

As same with the After one week of

previous procedures, After finish fiiling the observation, the
using the kfile #8 the root canal maka patient showed no
After filling almost
working length was dilakukan konfirmasi spontaneous pain, no
done, the operator
determined by apex menggunakan pain upon hot or cold
Four root canal was found that there is a
locator and the root microscope dan stimulation, no
filled using a vertical fifth canal on the
canal prepared with periapical x ray abnormality in the
condensation filling buccal side
the Mtwo system, after secara jelas bahwa 5 bucal or lingual
system with large taper mucosa
that filled with large saluran akar telah terisi
gutta-perchas and root Temuan ini, was taper gutta-perchas sempurna
canal sealer (AH plus) confirmed with CBCT, and AH sealer with No obvious
the fifth canal is the vertical condensation abnormality were
mesiolingual root canal and the last Final restoration
found on the tips of
temporarily sealed the roots The tooth rapaired
with zink oxide using composite resin
Gambaran Radiografi periapikal
CBCT was taken
Conclussion

– The root canal of the mandibula first premolar has the great anatomical
variations, far more than the second premolar of the mandible
– From the iterature review most studies report cases with two or threeroot
canal, The cases of four root canals are rare and the cases of five root canals on
the mandibular first premolar have been not reported before
– CBCT adalah radiografi yang sangat akurat untuk mengetahui jumlah saliran
akar dan letak pasti orrifice.
– 3D obturation adalah pilihan tepat untuk melakukan pengisian saluran akar agar
didapatkan hasil yang hermetis atau no void