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Locating Middle Mesial Canals

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Avoid Missing a Canal in Hiding

The mandibular molar is traditionally described as a tooth with two canals in the mesial root. However, studies have shown that their anatomy can vary significantly, and a third canal is found in 15-25% of all cases. When working without magnification, it is likely that the middle mesial canal will be missed. However, the application of magnification and ultrasonics to trough between the mesiobuccal and mesiolingual canals with a diamond coated insert (E2D or E6D) can increase the probability of finding the middle mesial canal by up to 50%.

E2D

E2D – Conical Diamond

E2D - Conical Diamond

The E2D – Conical Diamond is indicated for both side and end cutting, enlarging the ishtmus and troughing.

E6D

E6D – Pear Diamond

E6D - Pear Diamond

The E6D – Pear Diamond has excellent durability. It is used to locate canals, remove coronal obstructions, calcifications, restorative materials, cements (permanent and temporary), etc. The tip creates a smooth, flat, clean troughing groove that eases canal location. It can also be used to refine prep margins and box preps, and to remove caries.

R1

<img alt=" R1 Clearsonic™ Ultrasonic Endo Tip"

R1 – Clearsonic™

R1 - Clearsonic™

The R1 Clearsonic™ tip is used for selective cleaning of areas left untouched by traditional files. It is an excellent choice for retreatments, especially in oval shaped canals, and very effective in the removal of Gutta-Percha.

E15

E15 – The Finder™

E15 - The Finder™

The Finder is a diamond coated ultrasonic tip with an end diameter similar to the one of a #2 Gates Glidden drill (around 0.7mm). Designed initially to locate MB2 canals, it has been also used with great efficiency to locate calcified canals, locate isthmuses, and to prepare the root canal orifice. Its long shape allows enhanced visualization through the microscope. 

The orifice for the middle medial is usually located along the imaginary line connecting the mesiobuccal and the mesiolingual canals.

Step-by-Step Calcified Canal Location

1 – Using a diamond coated ultrasonic insert (E2D or E6D), create a groove connecting the mesiobuccal and the mesiolingual canals. This will remove secondary dentin, lighter in color.

2 – The dentin covering the pulp chamber floor and its mesial wall must be completely removed.

3 – Using a square section file, negotiate the middle mesial canal penetration, taking advantage of the sturdiness of these instruments.

<img src="Illustration-Locating-Middle-Mesial-Canals-1.png" alt="Illustration of groove created connecting canals.">

1. Create a groove connecting the mesiobuccal and mesiolingual canals.

<img src= " Illustration-Locating-Middle-Mesial-Canals-2.png" alt="Illustration of locating the middle medial canal office.">

2. Locate the middle mesial canal orifice along the groove.

<img src="Illustration-Locating-Middle-Mesial-Canals-3.png" alt="Illustration of a file to negotiate and prepare the canal.">

3. Use an appropriate file to negotiate and prepare the canal.

<img src="Images-Locating-Middle-Mesial-Canals-1.jpg" alt= Groove created to connect the mesiobuccal and mesiolingual canals.">

Achieved access to the Pulp Chamber.

<img src="Locating-Middle-Mesial-Canals-2.jpg" alt="Middle Medial canal located using ultrasonic.">

Middle Mesial Canal located using ultrasonic.

<img src=" Images-Locating-Middle-Mesial-Canals-3.jpg" alt="Final result of middle medial canal.">

Middle Mesial Canal final result.

Use the tip gently, as if you were using a 0.5mm mechanical pencil. The cutting does not come from the pressure applied, but from the vibration. Avoid working for more than 30 seconds without water flow – it can damage the hand piece due to overheating.

Dr Kanter Quote

“I have been impressed with the responsiveness and quality of the Helse ultrasonic tips.  They are my go to tips for custom bent apical surgery tips.  I routinely use them for non-surgical endodontic therapy and have been impressed with their durability and quality. .”

Dr. Keith Kanter, DDS

Journal Articles & Research

Middle Mesial Canals in Mandibular Molars: Incidence and Related Factors.

– Journal of Endodontics, January 2014

Starter Packs to get you going.

Starter Packs to get you going.

We’ve assembled three separate starter packs packaged with a procedure field guide to get you started supercharging ultrasonics in your practice.

Endo Starter Pack

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The Endo Starter Pack includes 6 Ultrasonics Tips to get you started with Pulp Chamber, Middle Third and Activation procedures.

Endo Master Pack

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The Endo Master Pack includes 12 Ultrasonics Tips for Pulp Chamber, Middle Third, Activation, Post Removal and Retreatment procedures.

Endo Guru Pack

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The Endo Guru Pack includes 18 Ultrasonics Tips for maximum flexibility with Pulp Chamber, Middle Third, Activation,Post Removal, Apical Surgery and Retreatment procedures.

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