September 2020 | Dr.Frency Joseph

A case with one canal orifice noted clinically in the coronal and middle third aspect, three apical splits were negotiated apically

Mandibular premolars are called endodontic enigma as there are many anatomical variations. Vertucci et al found that 25.5% of 400 mandibular premolars had two apical openings and 0.5% of the teeth had three apical openings. Presenting a ReRct case of mandibular first premolar with three or possibly four POE, History of root canal treatment about 10 years back. The patient came with symptomatic apical periodontitis, Multiple visit Rct with CaOH as ICM for two weeks, Only one canal orifice noted clinically in the coronal and middle third aspect, three apical splits were negotiated apically, Final apical preparation till 4% 25, Sonic (Endoactivator), Ultrasonic( U files) and Manual Dynamic agitation of irrigation solutions(17% EDTA, 5% Na Hypo, 2% CHX), I was not successful in inserting the three mastercones simultaneously into the apical splits.So checked the master cone fit by inserting into two canals at a time. So placed two of master cones initially and ultrasonic spreder used to soften and remove the coronal gp till the apical splits, then again Mani flare spreaders used as spreader and inserted gp to the other split. Rdaiographs were taken in between the procedure to check the placement, Sealer used -Zno eugenol sealer, Zical ( prevest), Obturation technique - Ultrasonic aided Latetal compaction. Interestingly sealer flowed into one more accessory canal which i couldn't recognize earlier. Core build up done with composites. Hope the tooth will serve for many more years.