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rev port estomatol med dent cir maxilofac . 2019;60(3):137-144 139

hol. The canals orifices were sealed with flowable composite chamber floor with a DG16 Endo Explorer, three main root ca-
resin. The access cavities were temporarily restored, and the nals (two mesial and one distal) with gutta -percha filling were
patients were referred for coronal rehabilitation. found, and a careful analysis of the area surrounding the dis-
tal canal revealed two untreated canals in the distal root (dis-
Case #1 tobuccal and distolingual root canals) (Figure 2). The three root
A 34 -year -old female presented for endodontic evaluation of canals had three distinct root canal orifices but merged togeth-
her mandibular left first molar (tooth 46). The patient’s chief er in the apical area, presenting a Gulabivala Type 9 (3 -1) con-
complaint was feeling pain when chewing. Her medical histo- figuration. After root canal negotiation and working length
ry was noncontributory. Clinical and radiographic examina- measurement, rotary instrumentation was performed to an F2
tion revealed a large and deep filling and previous endodontic ProTaper file. The root canals were disinfected, and a calcium
therapy (Figure 1). The periodontal ligament space was wider hydroxide dressing was used between visits. In the second
than in normal conditions. Tooth mobility was within physio- visit, a new disinfection protocol was performed, and the root
logical limits, and there were no periodontal pockets. Tooth 46 canal obturation was completed (Figures 3, 4 and 5). The
was tender to percussion, but not the adjacent teeth, which 19 -month follow -up showed no clinical or radiographic patho-
also responded normally to the ice sensibility test. The diag- logical findings (Figure 6).
nosis of previous endodontic treatment with symptomatic
apical periodontitis on tooth 46 was established. Endodontic Case #2
therapy was proposed and accepted by the patient. A 36 -year -old male patient came to an emergency visit with a
After proper anesthesia and rubber dam isolation, the ac- chief complaint of feeling permanent pain that increased
cess cavity was performed. During the exploration of the pulp when chewing with the mandibular right first molar (tooth

Figure 1. Pre -operative radiograph Figure 3. Working length measurement

Figure 2. Pulp chamber floor showing three root canals Figure 4. Final root canal filling
in the distal root