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<< Back to 2006 Case List

August 2006 – Assymetric Canal Filling is a Clue

This 64 Year old diabetic male was referred to me for recurring symptoms associated with a previously treated mandibular lefty first molar (#36).  Upon initial investigation of the referral’s film, the case looks decent.  Although the distal canal looks a bit undershaped, the canals seem to be filled close to the terminus. Many dentists would be happy with this radiographic result.

Unfortunately what they fail to realize is that the distal canal is “off center”. If we look closely at the distal canal fill, this “straight on” radiograph clearly shows that the distal is looks “shifted” to the mesial side of the root. This is a dead giveaway for a second distal canal.

My slightly mesial shifted digital radiograph (Fig.2 ) shows that there is a DB canal that was clearly not treated. (Remember the buccal object rule regarding shifted radiography!)

Fig. 1 Referral's film

Fig. 2 My preop film

Placement of a file in the DB canal  (Fig.3) clearly showed that it was separate.

Fig. 3 Working Length files in D canals

The final fill shows that the original treatment was inadequate and that the distal root has “balance” with respect to the fill. The fillings are well centered in the root and the symptoms disappeared.

The final mesial shifted images show the reason for the original persistent pathology.

Fig. 4 Cones in D canals

Figure 5 Final fill D canals

Fig. 6 Final Fill - Mesial shift