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Location of the ML Canal in Maxillary Molars

Location of the ML Canal in Maxillary Molars. Eric M. Rivera, DDS, MS Diplomate, American Board of Endodontics. Introduction. The goals of non surgical root canal therapy are to remove debris, prepare and obturate canals.

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Location of the ML Canal in Maxillary Molars

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  1. Location of the ML Canal in Maxillary Molars Eric M. Rivera, DDS, MS Diplomate, American Board of Endodontics

  2. Introduction • The goals of non surgical root canal therapy are to remove debris, prepare and obturate canals. • This is mostly contingent on the ability of the clinician to locate the canals successfully.

  3. Introduction • An inherent difficulty in treatment of the maxillary molar has been location of the mesial lingual canal in the mesial buccal root.

  4. % of Time That ML Canal Is Located

  5. % of Time That ML Canal Is Located • The ML canal occurs in approximately: • 60% of Maxillary First Molars • 30% of Maxillary Second Molars • Approximately 50% of the existing ML canals are negotiable, and therefore treatable.

  6. % of Time That ML Canal Is Located Mesiolingual canal location, in vitro 53-90% Gilles J, Reader A. 1990 Bjorndal A, Skidmore A. 1987 Weine FG. 1969 Hess W. 1925

  7. % of Time That ML Canal Is Located Mesiolingual canal location, in vivo 10-39% Weller NR, Hartwell GR. 1983 Hartwell G, Bellizzi R. 1982 Pomerantz H, Fishelberg G. 1974 Seidberg BH. 1973

  8. % of Time That ML Canal Is Located Different canal configurations

  9. Own Control

  10. Purpose • This presentation will demonstrate the enhanced ability of locating the mesial lingual canal in a maxillary molar using a surgical microscope.

  11. Technique • Access is triangular • A 557 or straight fissure bur is used to make the initial outline form. • Begin the access near the palatal canal. 3 Major Canal Orifices Exposed

  12. Technique • After the 3 main canals are located, remove the mesial ledge by using a 700L or a tapered fissure bur to uncover the mesial lingual canal orifice. ML Canal Located Under a Shelf on the Mesial Wall

  13. Technique • The MB orifice will be the guide to locate the ML. • This MB orifice must be clearly exposed. • Prepare a groove at that depth toward the lingual and slightly mesial into and through the shelf.

  14. MB ML Sectioned and Stained 1st Molar

  15. Technique • A groove will be made by extending lingual and slightly mesial towards the mesial lingual canal orifice.

  16. Technique • This groove may or may not open into a ML canal, depending upon whether it is present. • If a ML canal is not present, the MB canal will usually have a teardrop shape.

  17. Technique • If a significant ML canal is present, it can be located with a small file. • Try using glycerin as a lubricant. • If the ML canal is not negotiable, it is too small and cannot be treated.

  18. Conclusions • The location of the Mesial Lingual canal in the Mesial Buccal root facilitates treatment of maxillary molars. • This presentation has demonstrated a simplied approach for location of the ML canal, which helps conserve tooth structure.

  19. Conclusions • The most important consideration is that you look for the ML and/or other additional canals in every clinical case!!!

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