case_images: PMC10566008_01
case_images: Mandibular second premolar; A) Preoperative radiograph; B) Preoperative photograph; C) Dental operative microscope view of four orifices; D) Working length confirmation radiograph; E) Master cone confirmation radiograph; F) Postoperative radiograph; G) 4-month follow-up photograph; H) 4-month follow-up radiograph
case_images: IEJ-18-254-g001.jpg
case_images: PMC10566008_01_IEJ-18-254-g001.jpg
case_images: F1
case_images: A periapical radiograph showed a bifurcated root with a slight apical radiolucency and periodontal ligament (PDL) widening (Figure 1B). A fast break of the radiolucency of the main canal indicated the possibility of multiple root canals. The working length was determined as 19.5 mm for the buccal canals and 22 mm for the lingual one by an electronic apex locator (Minipex, Woodpecker, China) and then confirmed with radiography (Figure 1C). A final irrigation with 17% EDTA (Morvabon, Tehran, Iran) was performed to remove the smear layer (Figure 1D). Tehran, Iran) was applied as a temporary restoration and the patient was referred to the department of restorative dentistry for permanent restoration (Figure 1E, 1F). The tooth was clinically and radiographically asymptomatic at the 4-month follow-up session (Figure 1G, 1H).
case_images: CBCT views; A) Axial view; B) Sagittal view; C) Coronal view
case_images: IEJ-18-254-g002.jpg
case_images: PMC10566008_01_IEJ-18-254-g002.jpg
case_images: F2
case_images: CBCT confirmed the presence an extra mesial (M) canal (Figure 2).
case_images: Maxillary second premolar; A) Preoperative radiograph; B) Working length confirmation radiograph; C) Master cone confirmation radiograph; D) Postoperative radiograph; E) 4-month follow-up radiograph; F) 4-month follow-up photograph
case_images: IEJ-18-254-g003.jpg
case_images: PMC10566008_01_IEJ-18-254-g003.jpg
case_images: F3
case_images: Radiographic examination showed a slight PDL widening (Figure 3A), confirming the diagnosis of necrosis and chronic apical periodontitis. Tochigi, Japan) and the working length was determined as 20 mm for both canals by an electronic apex locator (Minipex, Woodpecker, China). The working length confirmation radiograph revealed a Vertucci's type VI root canal configuration (Figure 3B). The cleaning and shaping process was performed with T-Pro rotary instruments (Dental Perfect, Shenzhen, China) up to size 25/04 under copious irrigation with 5.25% sodium hypochlorite and normal saline alternately. Then, the K-file was removed, and another gutta-percha cone was inserted into the palatal path (Figure 3C). The tooth was restored temporarily and the patient was referred to the department of restorative dentistry for permanent restoration (Figure 3D). Due to the absence of clinical and radiographic signs and symptoms in the 4-month follow-up session, the treatment was considered successful (Figure 3E, 3F).