3 rooted Lower Second Molar

Fig. 1

Patient, male, in his early 30’s, was referred to our clinic for endodontic assessment and treatment of his lower right first and second molars.

The patient complained of the fact that the both the LR7 and LR6 were painful all the time, but especially upon biting.

Upon examination, both the LR7 and LR6 were carious, and the restoration on the LR6 was defective.

Both teeth were not responsive to cold and tender to percussion.

Radiographic examination revealed deep caries under the restoration of the LR6, with periapical radiolucency associated with both roots. The LR7 had deep caries and no periapical radiolucency. Careful examination of the pulp chamber and root morphology of the LR7 showed a possible additional root.

A diagnosis of chronic apical periodontitis that followed pulp necrosis was made.

The treatment options of non-surgical root canal treatment versus extractions were discussed with the patient, and he elected to undergo root canal treatments on both teeth.

Fig. 2

After adequate local anaesthesia the caries has been removed from both teeth, and there were restored with resin modified glass ionomer, as an interim restoration during the endodontic treatment. It has been explained to the patient that both teeth will require full coverage crowns after the endodontic treatment will be completed, for cusp protection.

Fig. 3

Upon access of the pulp chamber under rubber dam, the LR7 exhibited a 4-canal morphology- 2 separate distal canals and roots, and 2 separate mesial canals.

After adequate instrumentation (WOG up to Primary) and disinfection (sodium hypochlorite 5,25%, EDTA 17%) , a cone fit radiograph was acquired , showing the 3 roots and 4 canals.

Fig. 4

The canals were dried and obturated with bioceramic sealer (Totalfil BC sealer) in a single cone technique.