Fig. 1

A 57 years old patient came to my attention complaining about pain in the lower left area of the mouth.

The periapical x-ray shows the presence of a proximal decay that involved the first and second lower left premolar.

An accurate analysis of the X-ray showed a fast break in the line representing the root canal of the first premolar, suggesting the presence of a bifurcation.

Fig. 2

A multiple isolation with rubber dam is done

Fig. 3

Once removed the decayed tissue, the pulp of the first premolar is exposed.

Fig. 4

The root canal openings are connected by a line on the pulp chamber floor. This helps in locating the position of the orifices.

Fig. 5

The intra-operative x-ray shows the recording of the working length, evidencing the presence of two distinct root canals.

After that the tooth was shaped with rotary files.

Fig. 6

The appearance of the pulp chamber after the phases of shaping and cleaning.


Fig. 7

The gutta percha point fit

Fig. 8

After the root canal filling, a build up was done on the first premolar, while the decay was removed from the second premolar.

Fig. 9

There was an accidental pulp exposure that was treated with a direct pulp capping with MTA.

Fig. 10

A direct composite restoration

Fig. 11

A composite overlay was luted by using pre-heated composite material

Fig. 12

Post operative x-ray


A careful examination of the pre operative x-ray and a correct endo-restorative workflow can lead to a successful treatment of anatomic variations.


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