case_images: PMC10329761_01
case_images: Intraoral photographic views, A) Lateral view; B) Occlusal view of initial clinical examination, observing a geminated maxillary left second molar with caries; C) Caries removal, completed access cavity preparation, the four orifices are shown, B: Buccal canal, MB: Mesiobuccal canal, DB: Distobuccal canal, P: Palatal canal; D) Patient referred to restorative dentist for rebuilding the buccal wall and enhancing rubber dam isolation; E) Final compaction of gutta-percha; F) Well-functioning teeth with composite restoration at two months follow-up
case_images: IEJ-18-181-g001.jpg
case_images: PMC10329761_01_IEJ-18-181-g001.jpg
case_images: F1
case_images: The initial clinical examination revealed a geminated maxillary left second molar with severe decay on the occlusobuccal aspect (Figures 1A and 1B). Separately palatal root had one orifice leading to one foramen (Figure 1C). After removing caries, rubber dam isolation was compromised due to a lack of buccal wall (Figure 1C). At this point, the patient was referred to the restorative dentist to build a composite wall at the buccal side in order to facilitate the clamp placement of the rubber dam and isolation (Figure 1D). Afterward, an access cavity was prepared and four canal orifices were found as described earlier (Figure 1C). The final radiograph demonstrated densely condensed root canal fillings in all canals (Figure 1E, 2D). Two months follow-up revealed well-functioning teeth with normal status of periapical tissue with no mobility or abnormality (Figure 1F, 2E).
case_images: Periapical radiographic images, A) Initial periapical radiography; B) Confirmation of working length; C) Insertion of the master apical cones; D) Final radiograph demonstrating densely condensed root canal fillings in all canals; E) Periapical radiograph at two months follow-up, demonstrating normal periapical tissues
case_images: IEJ-18-181-g002.jpg
case_images: PMC10329761_01_IEJ-18-181-g002.jpg
case_images: F2
case_images: The periapical diagnosis was set to normal as no response to palpation and percussion test was observed; in addition to the normal periapical area of all roots demonstrated in the radiographic examination (Figure 2A). Working length was measured with an electronic apex locator (Minipex, Woodpecker, Guilin, Guangxi, China) and confirmed by radiograph (Figure 2B). Obturation consisted of warm vertical condensation technique by inserting the master cones (Figure 2C) and utilizing Fast Pack (Eighteeth Medical, Chang-Zhou, China), then filling the remaining coronal portion with the thermos-plasticized gutta-percha using Fast Fill (Eighteeth Medical, ChangZhou, China). The final radiograph demonstrated densely condensed root canal fillings in all canals (Figure 1E, 2D). Two months follow-up revealed well-functioning teeth with normal status of periapical tissue with no mobility or abnormality (Figure 1F, 2E).
case_images: CBCT images of the maxillary second molar, axial views with slice intervals at 1 mm
case_images: IEJ-18-181-g003.jpg
case_images: PMC10329761_01_IEJ-18-181-g003.jpg
case_images: F3
case_images: CBCT analysis shed light on the root canal system morphology: four orifices including buccal, mesiobuccal, distobuccal, and palatal were detected (Figure 3).