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

Figure 5. Post -operative radiograph Figure 6. 19 -month follow -up

36). His medical history was non -contributory. Clinical and Case #3
radiographic examination showed a very deep restorative fill- A 28 -year -old male patient presented for endodontic evalua-
ing on tooth 36 (Figure 7). No radiolucency was visible on the tion of the mandibular left first molar (tooth 46). The patient
periapical radiograph, and no periodontal pockets were pres- had a buccal swelling adjacent to tooth 46. He had no perma-
ent. Tooth 36 was sensitive to palpation and percussion and nent pain at this visit but had reported intense pain a few
did not respond to the ice sensibility test, contrary to the ad- days earlier. Clinical and radiographic observation revealed a
jacent teeth. The diagnosis of necrosis with symptomatic api- deep resin filling and previous root canal treatment on teeth
cal periodontitis on tooth 36 was established. 46 and 47 (Figures 14 and 15). A large periapical radiolucency
The tooth was anesthetized, a rubber dam was placed, and was identified surrounding both teeth on the periapical radi-
a proper access cavity was prepared. A careful exploration of ograph. No periodontal pockets were present. Tooth 47 had
the distal root, under magnification, showed a single root canal mobility within physiological limits while tooth 46 had class I
orifice that split into three root canals at the middle portion mobility. Tooth 45 responded to the ice sensibility test nor-
of the root (Figure 8) and then these merged together at the mally. Both teeth 46 and 47 were sensitive to percussion, but
apical area. The endodontic treatment procedures were very tooth 46 more than tooth 47. A diagnosis of previous endo-
similar to the previously described case (Figures 9, 10 and 11). dontic treatment with an acute apical abscess on tooth 46
Both the 14 -month and 3 -year recalls showed no clinical or was established. Although problems with tooth 47 were not
radiographic findings; however, the tooth was not restored yet discarded, they were not addressed at this appointment.
(Figures 12 and 13). The patient was again referred for oral After proper anesthesia, rubber dam placement and access
rehabilitation. cavity preparation, the pulp chamber was inspected under mi-

Figure 7. Pre -operative radiograph Figure 8. Three distal root canals with a common root
canal orifice