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Persistent pain after endodontic treatment is often associated with evidence of periapical pathology. Nonetheless, this case report presents two instances of persistent pain in maxillary premolars post root canal treatment (RCT), without evident periapical radiolucency on imaging. A 35-year-old Asian female experienced dull, aching pain on biting in tooth #25, whereas a 40-year-old Caucasian female reported similar symptoms in tooth #15. Both teeth showed tenderness to percussion but not palpation. Periapical radiographs and cone-beam computed tomography (CBCT) scans revealed completed RCT with apical transportation but no detectable periapical pathology. Thus, both teeth were diagnosed as previously treated with symptomatic apical periodontitis. Non-surgical retreatment successfully addressed untreated canal spaces, resolving symptoms. This report suggested persistent pain following RCT might stem from endodontic reasons, even in the absence of visible apical pathology on CBCT scans, highlighting the importance of thorough canal debridement to resolve symptoms associated with untreated canal spaces in apical transportation. Furthermore, this case report demonstrates that clinicians should make a diagnosis through thorough dental history and other clinical investigations, without relying solely on CBCT for the diagnosis of posttreatment endodontic pain. [ABSTRACT FROM AUTHOR]

Introduction: The isthmus is a communication between two or more root canals that contains pulp tissue. Its unpredictable location, variable prevalence, and anatomic complexity often result in challenging debridement. The knowledge of these factors may prove beneficial for successful endodontic treatment. The primary aim of this systematic review was to assess the prevalence and morphology of root canal isthmus (RCI) in human permanent teeth using micro-computed tomography (micro-CT) studies. The secondary aim was to assess the influence of demographic factors such as age, gender, and geographic region on the prevalence and morphology of the isthmus. Materials and Methods: An electronic search was conducted until January 2020. Studies published in the English language using micro-CT for the evaluation of isthmus prevalence and morphology were included. Sixteen articles met the inclusion criteria and were subjected to qualitative synthesis. Results: The prevalence of isthmus in the mesiobuccal root of maxillary first molars ranged from 8.9% to 70.8%, with maximum prevalence in the middle third of the root (49.50%–73%). The mesial root of mandibular molars had a prevalence ranging from 80.6% to 100% on full root analysis and 85%–88.89% in the apical third. Conclusion: The prevalence of RCI was higher in the mesiobuccal roots of maxillary molars and the mesial roots of mandibular molars, extending in the corono-apical direction with a complex and variable morphology. The influence of demographic factors on the prevalence of RCI could not be established clearly.

The purpose of this article is to describe a clinical case of a maxillary first molar with three roots and six root canals.The clinical detection of the six canals was made using a dental operating microscope and confirmed using multiple angled radiographs.This report serves to remind clinicians that such anatomical variations should be taken into account during endodontic treatment of the maxillary molars.

Aim: The purpose of this in vitro study is to provide clinical data on the presence of the second canal in mandibular incisor teeth of Saudi Arabian Samples. Materials and Methods: Eighty extracted human mandibular incisors were collected from Saudi patients. The teeth were accessed by small round bur then placed in 5.25% sodium hypochlorite for 24 hours to dissolve the organic debris. Indian ink was injected inside the root canal systems under negative pressure. The teeth were decalcified in 5% nitric acid for three days then dehydrated in different concentrations of ethyl alcohol. Following the decalcification process, the teeth were cleared in methyl salicylate and evaluated according to Vertucci′s classification. Result: Fifty six of both mandibular central and lateral incisor teeth (70%) had type I canal configuration (one main canal and one main apical foramen), while the remaining 30% of the sample (24 teeth) had a type III canal configuration (two separate canals and merged into one canal before exiting the tooth through single apical foramen). Conclusion : The incidence of two canals in mandibular incisor teeth is about one third of the examined Saudi Arabian samples with no difference between the centrals and laterals. The clinician should deal with these teeth as if they have two canals unless it is proved otherwise.

Inability to find and manage an extra canal (s) is an important cause forfailure of root canal treatment. So, for effective and successful endodontic therapy, root canal morphology and variations should be considered. The purpose of this case report is to present a case of a 58-year-old Saudi male patient with anatomical variations in permanent maxillary left canine in which there is an additional canal (type II of Vertucci classification) was located and treated.