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Variable Anatomy

Posted May 18 2009 11:11pm
Endodontists factor variable anatomy of teeth on a day to day basis. Data exists in the dental literature that basically can break down tooth by tooth the odds of having a certain number of roots and canals. We all know that there are typically 4 canals in a maxillary first molar but sometimes there can be as few as 3 and as many as 6. Sometimes nature throws us curve balls and this can make dentistry quite difficult.

Several weeks ago, I extracted this maxillary third molar on a patient. With the complexity of surrounding anatomy in the maxillary posterior region, nothing on the radiograph led me to expect what I would find when extracting the tooth.

The tooth came out very easily. After irrigating and packing some gauze, I cleaned off the tooth and was suprised at what I found. Here are some photos.

Obviously the separate distal root is a rare anomoly on a maxiallary third molar. The root itself is very spindly and curved. I am not quite sure how I got it out with out breaking, and that is what makes me wonder. If I had broken that distal root, I would have had no thought to go back and look for it. Had it broken in the right spot on the tooth, maybe it would not have been apparent that there was a root there with the tooth covered in blood and saliva. How many roots like this get broken off and go unretrieved? I'm sure there are many more than we know. Had this been a maxillary second molar recieving endodontic therapy, there are strong odds that this canal would have been missed and untreated. How many canals like this are never found in endodontics? How many times is ignorance bliss in dentistry? Sometimes it is scary to think about!
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