Dental Tribune South Asia No. 10, 2023

Polychromatic layering technique—full protocol: a case report / Digital Dental Craftsman Convention for lab technicians / How to handle complex endodontic cases / Clinical trials begin for drug that regrows teeth / A rare variation in the root canal anatomy of a premolar

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Table of contents

The World‘s Dental Newspaper
South Asia Edition
Published in India

www.dental-tribune.com

DIGITAL DENTISTRY

Vol. 1, No. 10

TOOTH REGENERATION

ENDODONTICS EDITORIAL

Digital Dental Craftsman Convention
for lab technicians

Clinical trials begin for drug that
regrows teeth

A rare variation in the root canal anatomy of a premolar

Page 05

Page 07

Page 08

Polychromatic layering technique
—full protocol: a case report
By Dr Neha Gupta

Evaluation and mock up

Vanini described an anatomical
stratification technique that goes
beyond
the
typical
three
dimensions (hue, chroma, value)
of color. The technique, especially
useful when esthetic demands are
high,
enables
dentists
to
predictably create life-like esthetic
restorations
that
are
indistinguishable from natural
teeth.1, 2

Introduction
A 10-year-old male patient
reported with a complaint of
trauma to the upper left central
and lateral incisors, involving the
enamel and dentin. Direct
composite was used in multilayers and the smile was restored.
This article explains detailed steps
in the polychromatic layering
technique with special emphasis
on the finishing and polishing
protocol. 3M Espe Filtek Z350 XT
was used with a universal bonding
agent.

1

2

3

4

5

6

Fig. 1:
Intra-oral view of the initial
situation (Class IV fracture with 11
and 12).
Fig. 2:
A close-up smile view.
Fig. 3:
Shade was evaluated with the
“Button technique”. A2 Dentin was
used for inner layer and incisal
halo, A2 Body for mid layer, Clear
Translucent for opalescence and
A2 Enamel for outer layer.

www.dental-tribune.com

Fig. 4:
A monochrome picture helps
evaluate the value. Empress Direct
Enamel A2 was chosen for this
case.

7

Fig. 5:
Quick intra-oral mock-up was
performed without etching and
bonding. This can also be done
with the chosen shades of
composite to roughly evaluate the
selected shade.

Fig. 6:
Occlusion was checked and
adjusted accordingly.
Fig. 7:
Once verified, a putty index
was made with A-Silicone to
record the palatal surface.

[2] =>

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2

Dental Tribune South Asia Edition | 10/2023

Bonding and palatal shell
Fig. 8:
After thorough prophylaxis,
the concerned site was isolated
with a rubber dam and further
retraction of gingiva was achieved
with the help of floss ties.
Fig. 9:
Using fine grit bur all
unsupported enamel was removed
and 2mm short bevel was given.

8

9

Fig. 10:
The bevel allows better
integration
between
the
composite restoration and the
remaining dental tissue.
Fig. 11:
Selective etching with 37%
Phosphoric acid was used to etch
the enamel for 20 seconds.

10

11

Fig. 12:
After thoroughly rinsing for
20 seconds the tooth was dried
completely.
Fig. 13:
A single bond universal from
3M was used as the adhesive. The
bond was applied in scrubbing
motion for 10 seconds and the
excess was removed with a fresh
applicator tip and light cured.

12

13

Fig. 14:
The silicone index was then
used to build the palatal shell
which served as the base to further
layer composite.
Fig. 15:
The extent of the palatal
surface was marked using a probe.
Fig. 16:
Clear translucent shade was
used to build the palatal surface.

15

15

16

17

18

Fig. 17:
Light curing.
Fig 18:
With the final palatal shape it is
easy to foresee the final shape for
the
final
composite
resin
restoration.

[3] =>

NEWS
Dental Tribune South Asia Edition | 10/2023

3

Contact build-up with band and wedge
Figs. 19 & 20:
The sectional matrix for
posterior teeth was used in a
vertical direction and stabilized
with wedge on both mesial and
distal side.
Fig. 21 & 22:
Mesial wall was built with A2
body shade.

19

20

Fig. 23:
Interproximal build-up was
done on both mesial and distal
side.
Fig. 24:
After interproximal build-up,
the band and wedge were
removed, leaving behind the
scaffold for further layering.

21

22

23

24

Layering protocol step by step
Fig. 25:
A2 Dentin was used for the
inner layer and dentinal structures
were created using 3 well-defined
lobes.
Fig. 26:
It was bulked up till the start of
the bevel slightly covering the
bevel.

25

26

Fig. 27:
A2 Body was used to build the
mid layer and multiple lobes were
created to mimic the adjacent
tooth.
Fig. 28:
A2 Dentin which is opaque was
used at the incisal edge to create
an incisal halo.

27

28

Fig. 29:
Clear Translucent was used to
fill the space between the incisal
edge and the mamelons in order
to increase the translucency at the
incisal third.
Fig. 30:
Final A2 Enamel was used for
outer layer giving it proper contour and final form.

29

30

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4

Dental Tribune South Asia Edition | 10/2023

Polishing protocol and post-op

31

32

Fig. 35:
Sof-Lex finishing super fine
disc was used for final finish and
shine at high speed with irrigation
.
Fig. 36:
The secondary anatomy was
obtained using Shofu white finishing stone to create undulation
often referred to as the “Eiffel
Tower”. It is always important to
evaluate the depth and the extension in the neighboring tooth so as
not to exaggerate its presence.
Fig. 37:
Diamond-impregnated
polisher was used for surface
refinement at high speed with
irrigation.
Fig. 38:
Buff was used for the final
glass-like finish and polished at
high speed with irrigation.

33

34

Fig. 39:
Final
composite
resin
restoration immediately after the
polishing procedure.
Fig. 40:
Life-like
restoration.

appeal

to

final

Fig. 41:
Note the natural integration of
the composite resin with the
dental tissue.

35

36

37

38

Conclusion
The article demonstrates how
using the right protocols and
armamentarium for composite
materials can give life-like results
in a short time in a minimally
invasive way. No single layering
technique can ensure a 100%
success rate. Regardless of the
technique, establishing good
secondary and tertiary anatomy
and thorough polishing are the
key steps that make a restoration
look more natural. Composite is
the perfect material for allowing
correction
of
mistakes
or
improvement.

References

39

40
Fig. 31:
Fig. 33:
Primary anatomy was marked
Sof-Lex finishing medium disc
using a lead pencil.
was used to reduce the surface
roughness at a slow speed without
Fig. 32:
irrigation.
Sof-Lex finishing coarse disc
was used to define the mesial and
Fig. 34:
distal line angle at slow speed
Sof-Lex finishing fine disc was
without irrigation.
used to smoothen the surface at
high speed with irrigation.

41

1.
Vanini L. Conservative
composite restorations that mimic
nature. A step–by-step anatomical
stratification technique. J Cosmet
Dent 2010; 26(3): 80–98
2.
Vanini L, Mangani FM.
Determination and communication
of color using the five color
dimensions of teeth. Pract Proced
Aesthet
Dent.
2001
JanFeb;13(1):19-26; quiz 28. PMID:
11301528.

About
Dr Neha Gupta graduated
from D.Y Patil Dental College &
Hospital, Navi Mumbai. Member
of the Indian Academy of Aesthetic
and Cosmetic Dentistry.Winner of
Style Italiano talent and Podium
Speaker at the 1st Style Italiano
International Conference in India.

[5] =>

NEWS

Dental Tribune South Asia Edition | 10/2023

Digital Dental Craftsman Convention
for lab technicians
Interview with Drs. Pankaj Chivate & Vipin Mahurkar
7. What future events are
planned by ISDD?
Pankaj Chivte: After a highly
successful convention in Pune last
year, attended by more than 800
clinicians with 12 international
speakers and 12 industry partners,
we plan to hold such conventions
bi-annually. Stay tuned for our
next
event
scheduled
for
November 2024. Additionally, we
are currently hosting the Digital
Dental Craftsman Convention
(DDCC), the first conference for
dental technicians and dental
practitioners, in Mumbai in
October 2023. Furthermore, we
are planning to host a digital
dental conference for students in
Gujarat early next year. Our aim is
to continue fostering the growth
and development of digital
dentistry in India through these
initiatives.

Digital Dental Craftsman Convention 2023 aims to bring dental technicians and dentists under one roof of digital dentistry. (Image: Canva)

By Dr Rajeev Chitguppi,
Dental Tribune South Asia
In this interview with Dental
Tribune South Asia, Dr. Pankaj
Chivte, the President of the Indian
Society of Digital Dentistry (ISDD),
and Dr. Vipin Mahurkar, the
Organizing Chairman of the Digital
Dental Craftsman Convention
DDCC 2023 to be organized by
ISDD in Oct 2023 in Mumbai
explain the motivation behind
founding ISDD and organizing
DDCC, and their future plans.
1. What was the motivation
behind establishing ISDD, and
who are its founders?
Pankaj Chivate: The advent of
digitization has brought about
significant changes globally and
has made a substantial impact in
India. Digital technology is
revolutionizing various fields of
medicine, including dentistry,
where tools like scanners, CBCT,
CAD/CAM, 3D printing, and milling
are transforming patient care. To
keep pace with this rapid
advancement in digital dentistry
knowledge and technology in
India, the “INDIAN SOCIETY OF
DIGITAL DENTISTRY – ISDD” was
officially founded in 2022 by a
group of experienced and techsavvy dentists. The founding
members include Drs. Ratnadeep
Jadhav, Vijay Tamhane, Pankaj
Chivate, Sanjay Asnani, Suresh
Ludhwani, and Kaustubh Patil.
These founders, who are also
multi-practice owners, share a
deep passion for digital dentistry
and are dedicated to promoting
advanced, innovative training in
digital dentistry in India, with the
aim of enhancing the quality of
dental work and creating new

opportunities for Indian dentists.
Presently, we have been joined by
20 clinicians from various parts of
India to expand ISDD’s activities to
different states.
2. What is the current market
size of digital dentistry, and how is
it reshaping the dental industry in
India?
Pankaj Chivate: In terms of
revenue, the global digital
dentistry market was estimated to
be valued at $7.2 billion in 2023,
and it is expected to experience a
compound annual growth rate
(CAGR) of 10.9% over the next five
years, reaching $12.2 billion by
2028. Furthermore, this market is
projected to undergo substantial
growth, with a value CAGR of
13.1%, ultimately reaching $16.3
billion by the close of 2032.
Although digital dentistry’s
penetration in the Indian market is
currently limited, we anticipate
rapid growth over the next five
years that will revolutionize the
dental
landscape
in
India.
Presently, there are approximately
3,000 intraoral scanner users in
India, and we foresee a remarkable
tenfold increase in this number
within the next five years. Digital
dentistry will enable dentists to
access expert opinions from
specialists in various cities and
receive high-quality lab work from
different parts of India, thereby
elevating the overall standards of
dentistry in the country.
3. What is the rationale behind
organizing the Digital Dental
Craftsman Convention (DDCC)?
Vipin Mahurkar: The pace of
evolution in digital dentistry is so
rapid that both dental technicians
and dentists face significant

challenges in keeping up with its
advancements. DDCC is a sincere
endeavor to bring together dental
technicians and dentists in a single
event.
DDCC
reflects
our
commitment to staying at the
forefront of progress, embracing
digital tools and technologies to
create a transformative impact on
the dental field. Dental lab
technicians will get an amazing
opportunity to gain awareness
and training from innovative
multinational companies, industry
leaders,
and
accomplished
speakers through lectures and
demonstrations covering the
latest developments in digital
dentistry. The event is scheduled
for October 21-22, 2023, in
Mumbai. The venue Hotel Orchid
is also very easy to reach as it is
located just next to Mumbai
domestic airport.
4. What sets DDCC 2023 apart
from other conventions?
Vipin Mahurkar: DDCC stands
out as the first-ever dental labfocused
event
that
offers
technicians
a
much-needed
platform to discover, learn, and
network. It distinguishes itself by
providing
practical-oriented
sessions for technicians who wish
to embrace digital dentistry fully.
The event encompasses all aspects
of digital dentistry, including
scanning, designing, milling, and
printing,
which
will
be
demonstrated to attendees.
In addition to expert lectures
and
demonstrations,
DDCC
features a panel discussion on
implant prosthetics and lab
workflows,
offering
a
troubleshooting session where
participants can seek answers
from industry experts. DDCC

offers a glimpse into the broader
realm of dentistry, highlighting
emerging trends and concepts
that are poised to supersede
current techniques and devices.
5. Who would benefit most
from attending DDCC? Who
should consider participating in
the event?
Vipin Mahurkar: DDCC is
highly beneficial for both dental
technicians and dentists who
aspire to master the art and
science of dentistry by harnessing
the power of technology and
digital dentistry. The digital
revolution has blurred the lines
between dentists and dental
technicians, requiring both to be
well-versed in the latest changes
in CAD designing, and fabrication
through milling and printing.
Digital Dentistry can elevate an
average dental technician into a
star performer who consistently
delivers high-quality dental work.
Therefore, attending DDCC and
connecting
with
industry
experts,
innovators,
and
forward-thinking suppliers is an
excellent
investment
in
professional growth. This event
provides a valuable opportunity
for all dental professionals to learn
from industry leaders and
transform their mindset and
approach.
6. How can individuals
register for DDCC 2023?
Vipin Mahurkar: To register
for DDCC 2023, visit the ISDD
website to make an online
payment. Alternatively, you can
simply send your details via
WhatsApp to +91 89839 34493,
and our team will assist you with
the registration process.

About

Dr. Pankaj Chivte, the President of
the Indian Society of Digital
Dentistry (ISDD)

Dr. Vipin Mahurkar, Organizing
Chairman, Digital Dental Craftsman
Convention DDCC 2023

[6] =>

NEWS

Dental Tribune South Asia Edition | 10/2022

How to handle complex
endodontic cases
Interview with Dr Ruth Pérez-Alfayate

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prior written permission of Dental
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Dr Ruth Pérez-Alfayate will be a speaker at ROOTS SUMMIT 2024, which will be held from 9 to 12 May in Athens. (Image: ROOTS SUMMIT)

By Franziska Beier,
Dental Tribune International
KRegistration
for
ROOTS
SUMMIT 2024 is open, and the
organisers would like to introduce
some of the great speakers and
their lecture topics for next year’s
event. One of them is Dr Ruth
Pérez-Alfayate,
an
associate
professor at the Faculty of
Biomedical and Health Sciences at
Universidad Europea in Madrid in
Spain. In this interview, she
introduces her lecture, titled
“Complex
diagnosis
in
endodontics”, and explains why
she decided to speak at the
congress.
Dr Pérez-Alfayate, in some of
the more complex endodontic
cases, dental professionals have to
use invasive tests in order to be
able to make a clear diagnosis. For
which cases are these invasive
tests appropriate, and how do
dental professionals keep a
balance
between
invasive
treatment measures and the desire
to keep the treatment minimally
invasive?
These
tests
might
be
appropriate when there is doubt
about a vertical root fracture,
when there is severe pulpitis, when
more than one tooth is suspected
of this pathology and is radiated,
or when pulp necrosis needs to be
identified in a patient presenting
with a low pain threshold.
The balance, in my opinion,
can be found when we understand

the expectations of our patients in
the first instance. Patient safety,
the concept of “do no harm” and
minimally invasive treatment
should prevail and must be a
priority for us. All of these concepts
can still be applied even when we
need to use invasive tests for
diagnosis.
In some cases, even after the
use of diagnostic tests, the dental
professional can be left with a high
level of doubt. What is the reason
for this?
The reality is that currently we
do not have any test that is 100%
objective. This means that one or
two tests are not sufficient. We
need to find a diagnostic protocol
that gives us as much information
as possible.
What are some of the
endodontic diagnostic tests for
complex cases, and why can they
be challenging?
The diagnostic tests include
exploratory surgery, selective
anaesthesia and cavity testing.
Deciding when or when not to use
them is the challenge.
Are
there
any
future
developments
in
endodontic
diagnostics that you can tell us
about?
Some researchers are working
on various devices, such as pulse
oximeters, real-time ultrasound
and ways to evaluate the actual
pulp status before conducting
treatment.

What will be the main learning
objectives of your lecture at
ROOTS SUMMIT 2024?
I will describe a diagnostic
protocol for endodontists to
enable them to understand which
clinical situations require a
complex diagnosis, and I will
propose how they should act in
these specific situations.
What made you decide to
participate in the upcoming
ROOTS SUMMIT?
I have attended this congress
many times, and I have to say it is
one of my favourites. Also, the
organisers of ROOTS SUMMIT are
three people whom I admire
greatly, and when they ask you to
come to their congress, it is
impossible to say no—it is an
immense privilege.
I know I will learn a great deal
from the best and humblest
endodontists in the world. I am
sure this will be a great congress,
and I hope to see as many people
as possible there. Do not miss it!

From the Editor’s
desk
For 20 years now, ROOTS
SUMMIT meetings have been
taking place around the world
including Canada, the United
States of America, Mexico, the
Netherlands, Spain, Brazil, India,
the United Arab Emirates and
most recently Czech Republic in

2022. In 2024, ROOTS SUMMIT will
be coming to Athens.
You can expect the great
experiences that ROOTS SUMMIT
participants always enjoy in
addition to the same high-calibre
level of clinical practice that
members of the online endodontic
study group have relied on for
over 20 years.
This
includes
practical
information provided by panelists
from nine countries and technique
tips that can be immediately
incorporated
into
improving
practice.
ROOTS SUMMIT 2024 will have
participants joining from more
than 50 countries,

Dental Tribune International GmbH
makes every effort to report clinical
information and manufacturers’ product news accurately but cannot assume responsibility for the validity of
product claims or for typographical
errors. The publisher also does not
assume responsibility for product
names, claims or statements made
by advertisers. Opinions expressed
by authors are their own and may
not reflect those of Dental Tribune
International GmbH

DENTAL TRIBUNE SOUTH ASIA
EDITION

PUBLISHER
Ruumi J. DARUWALLA
CHIEF EDITOR
Dr. Meera VERMA

CLINICAL EDITOR
Dr. Dilip DESHPANDE

RESEARCH EDITOR
Dr. Shobha DESHPANDE

ASSOCIATE EDITOR
Dr. GN ANANDAKRISHNA
EXECUTIVE EDITOR
Dr. Rajeev CHITGUPPI

ASSISTANT EXECUTIVE EDITORS
Dr. Riddhi D. TELISARA
DESIGNER
Anil LAHANE

PRINTER
Mehernosh MISTRY
Burzin MISTRY
Ampersand, Mumbai, India

[7] =>

NEWS

Dental Tribune South Asia Edition | 10/2023

Clinical trials begin for drug that
regrows teeth
disorder that results in the absence
of six or more baby and/or adult
teeth, may find solace in the fact
that a clinical trial tailored to their
specific needs is slated to
commence in 2025.
In conclusion, the chronicle of
Toregem Biopharma’s relentless
pursuit of dental innovation is
nothing short of a scientific marvel.
The prospect of regrowing teeth
has shifted from the realm of
dreams to the brink of reality, and
it is a testament to the ingenuity
and dedication of these visionary
scientists. As we stand at the
precipice of a dental revolution,
the ability to regrow one’s teeth
may soon be within our grasp.

Japan pharma startup developing world-first drug to grow new teeth enters clinical trials. (Image:Toregem Biopharma & Canva)

By Dr Rajeev Chitguppi,
Dental Tribune South Asia
Japanese scientists are on the
brink of a dental revolution with
their new drug that has sparked
hope for growing teeth. Clinical
trials are set to begin for Toregem
Biopharma’s drug that has
successfully grown new teeth in
animal test subjects.
In a remarkable breakthrough
that could revolutionize dental
healthcare, a team of Japanese
scientists from the innovative
pharmaceutical startup Toregem
Biopharma are on the verge of
introducing a groundbreaking
drug that may enable the growth
of new teeth. The development
has garnered widespread attention
and has raised hopes for
individuals suffering from toothrelated issues.
At the forefront of this medical
innovation is Dr. Katsu Takahashi, a
distinguished researcher and the
head of the dentistry and oral
surgery department at the
esteemed
Medical
Research
Institute Kitano Hospital. Dr.
Takahashi’s tireless pursuit of a
seemingly elusive dream – the
regrowth of teeth – began in 2005
when he initiated extensive
research at Kyoto University.
The foundation of their
groundbreaking discovery hinges
on a specific gene found in mice,
known
as
USAG-1,
which
profoundly
influences
the
development of their teeth. The
scientists uncovered the gene’s
dual role, capable of either
promoting or impeding dental

growth. The pivotal idea that
emerged was to create a
“neutralizing antibody medicine”
designed to effectively block the
adverse effects of the USAG-1
gene, thereby unlocking the
potential for tooth regeneration.
Initial experiments conducted
on mice yielded promising results
as the new medicine induced the
growth of fresh teeth, leaving the
scientific community astounded.
However, the team was not content
to rest on their laurels; their
ambition extended to validating
their findings in animals whose
dental patterns closely mirrored
those of humans – ferrets.
The ferrets subjected to the
experimental drug demonstrated
remarkable tooth regeneration. It
was a pivotal moment in their
journey toward making tooth
regeneration come true.
The upcoming phase in this
extraordinary odyssey is nothing
short of monumental – human
trials. The Toregem Biopharma
team is poised to commence
clinical trials as early as July 2024,
marking a critical juncture in their
quest to make transformative
medicine available to the masses.
Their ambitious goal is to bring the
drug to market by 2030, ushering
in an era where individuals with
dental issues can regain their
smiles.
However, this story is not
solely about adults seeking to
replace lost teeth; it carries a
message of hope for a select
group of children. Those afflicted
by anodontia, a rare genetic

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NEWS

Dental Tribune South Asia Edition | 10/2023

A rare variation in the root canal anatomy of
a premolar
morphology before initiating the
treatment. Mandibular premolars
are usually single-rooted. The
present case shows a variant with
two canals. A patient presented
with a large draining buccal
abscess that showed a large peri
apical lesion with an incompletely
obturated canal on the preoperative intraoral radiograph.
The application of cone beam
computed tomography (CBCT) in
the diagnosis and management of
endodontic cases is rising steadily.3
The patient was sent for 3-D
imaging (CBCT) for more details
and a precise diagnosis.
The CBCT imaging revealed
the following findings with tooth
34
• A partially endodontic treated
34.
• Single root with the canal
bifurcating about 10.5 mm
below the crown to form buccal
and lingual canals.

Sound knowledge of anatomical variations is essential for excellent endodontic outcomes. (Image: Canva)

By Dr Shail Jaggi
I start my editorial journey
today as the editor of Endodontics
& Biomimetic Dentistry with two
topics in mind:
1. The exploration of biomimetic
approaches, delving into the
fascinating realm of mimicking
nature to restore and enhance
dental function! Quite excited
and so looking forward.
2. The science of endodontics is
witnessing interesting new
developments, where lasers
seem to be making a
comeback. Should we be
looking
out
for
laserempowered endodontics? I
will cover this in one of my
future editorials.
With this new role of writing, I
look forward to promoting
excellence in dentistry and optimal
patient care.
Good endodontics is the
foundation for any great dental
work.
The
philosophy
and
techniques in endodontics have

evolved tremendously in the last
30 years, and thanks to more
research and advanced CT studies
carried out on large samples, we
are now aware of the vast and
complex possibilities of the
internal anatomy of single-rooted
as well as multi-rooted teeth. 1,2
The Vertucci classification
shows variations in the different
anatomy
configurations
in
premolars.
Classification

Configuration
pattern

Type I

1-1

Type II

1-2-1

Type III

1-2

Type IV

1-2-1-2

e, f, g

Additional
types

1-3-2; 1-3;
1-2-3

(Table 1. Vertucci’s classification
for premolars)
Variant anatomy is one of the
biggest challenges in endodontics
that
necessitates
a
better
understanding
of
canal

Fig. 1: Vertucci Calssification-Premolars.

Fig. 2: Pre-op radiograph.

[9] =>

NEWS

Dental Tribune South Asia Edition | 10/2023

Fig. 4: Post-op xray.

Discussion

Fig. 3: Scan sections.

• Buccal canal filling short of
apex.
• Missed lingual canal space
noted. A suspected perforation
involving the mesial dentinal
wall along the mid-canal region
(near the bifurcation).
• Large
periapical
lesion
measuring 8.0 x 8.0 x 5.0 mm
perforating buccal plate along
with mild external root end
resorption. (Fig. 3)
Treatment plan
The use of magnification is
becoming more common in
endodontic practice, increasing
precision and treatment success
rate.4
Re-treatment was initiated
under magnification with a Dental
Operating Microscope that helped
us locate the missing canal.
Close examination and canal
exploration
showed
no
perforation.
The canal was disinfected
under isolation with a 5.5% sodium
hypochlorite solution, and a
calcium hydroxide dressing was
placed for three weeks, followed
by obturation with a bioceramic
sealer by a 3-D obturation
technique.
The case can be classified as
type 1-3-1 of the Additional group
of Vertucci Classification (Figs. 4 &
5).

Fig. 5: Lateral exit.

Literature has documented
multiple variations in canal
configurations of the lower
bicuspid. The current case shows a
variation in Vertucci Classification
Additional type 1-3-1.
The case was treated and the
lingual canal was missed out
leading to a large periapical lesion
and drainage. 3-D imaging
revealed a single root and a missed
lingual canal. The internal anatomy
was complex, and if you observe
the post-operative radiograph
closely, it shows the presence of a
small lateral canal with an
independent exit.
This brings us to discuss the
significance of good irrigation
protocols during endodontic
treatment. Successful filling and
sealing of lateral canals depends
on good irrigation and disinfection
techniques.

Conclusion
This clinical case shows a rare
root canal configuration of 1-3-1
and highlights the importance of
knowing the variant morphology
of
a
mandibular
bicuspid,
reminding
us
that
every
endodontic case needs full
attention to detail on close
inspection of the radiographs
before making the diagnosis and
treatment plan.
Sound
knowledge
of
anatomical variations in anatomy
is essential for excellent clinical
outcomes. A combination of
knowledge, tactile sensation,
good radiographic technique, 3-D
imaging,
followed
by
magnification, perfect isolation,
and irrigation, along with adequate
3-D sealing of the canals lead to
successful endodontic outcomes.

References
1.
Kottoor J, Albuquerque
D, Velmurugan N, Kuruvilla J: Root
anatomy and root canal configuration of human permanent mandibular premolars: a systematic review. Anat Res Int. 2013,
2013:254250. 10.1155/2013/254250
2.
Albuquerque D, Kottoor
J, Hammo M: Endodontic and clinical considerations in the management of variable anatomy in mandibular premolars: a literature review. Biomed Res Int. 2014,
3.
Patel S, Brown J, Pimentel T, Kelly RD, Abella F, Durack C:
Cone beam computed tomography in endodontics – a review of
the literature. Int Endod J. 2019,
52:1138-52. 10.1111/iej.13115
4.
Low JF, Dom TNM, Baharin SA: Magnification in endodontics: a review of its application and
acceptance among dental practitioners. Eur J Dent. 2018, 12:610-6.
10.4103/ejd.ejd_248_18

About
Dr Shail Jaggi, MDS is a microendodontist
and
restorative
dentist practicing for over 25 years
dedicated
to
advanced
endodontics
and
cosmetic
dentistry. Dr Shail has a multispecialty
5-chair
practice
‘Dentalwiz’ on weekdays, and her
weekends are dedicated to
training programs at Dentalwiz
Smile Institute - her exclusive
training center

[10] =>

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[cover] => Dental Tribune South Asia No. 10, 2023

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