Radix Entomolaris: Case Report with Clinical Implication

Fig. 1

CASE 1

A 12-year-old female came with a chief complaint of severe pain in the left lower back tooth region since last two days. The pain aggravated on taking hot food and beverages, and lasted for 2–3 hours. On clinical examination, the mandibular left first molar was deeply carious and was diagnosed with irreversible pulpitis. The radiograph of the mandibular right first molar was normal without any periapical changes.

Fig. 2

Access cavity preparation was done after rubber dam isolation and under local anesthesia with an endo access bur.pre-endo build up was done. The first distal canal was located towards the buccal side indicating the presence of one additional canal on the lingual side. The shape of the access cavity was modified from triangular to a trapezoidal form to search for the additional canal orifice. DG-16 endodontic explorer was used to locate the root canal orifices and 15 # K-file was used to establish patency of the canals. Working length was determined using apex locator. The canals were cleaned with 2.5% sodium hypochlorite followed by saline and 17% EDTA was used as final flush.

Fig. 3

Obturation was performed with gutta-percha points after application of bioceramic root canal sealer.

Fig. 4

Restoration was done with composite resin and a post-obturation radiograph was taken.

Fig. 5

Radiographic workflow.

Fig. 6

CASE 2

A 38-year-old female patient came to my clinic with a history of pain in the lower right side in relation to lower right first molar. On clinical examination, right mandibular first molar was found to be restored with amalgam restoration. Radiographic interpretation revealed the presence of apical periodontitis and pulpotomy. Local anesthesia was administered and rubber dam was applicated.

The old restoration was removed with round bur in combination with ultrasonics in the pulp chamber. The canal orifices were negotiated with DG-16 explorer. The fourth canal was negotiated after slight ultrasonic widening of the distal orifice in respect of low of color.

Fig. 7

Access cavity and four distinct canal orifices.

Sodium hypochlorite was used for disinfection of the root canal system.

Fig. 8

After location and enlargement of the orifice of the RE, initial root canal exploration with small files (size 10 or less) together with radiographical root canal length and curvature determination, and the creation of a glide path before preparation, is step-by-step actions that was taken to avoid procedural errors.

Ultrasonic tips were used to remove the isthmus between the distal canals.

Fig. 9

The gutta cone fit, with radiographical exposure, confirmed the presence of an RE.

Fig. 10

All canals were filled with gutta-percha and bioceramic root canal sealer.

Fig. 11

Restoration was done with composite resin and a post-obturation radiograph was taken.

Fig. 12

CASE 3

A 10-year-old female came for endodontic treatment of mandibular right first molar with a chief complaint of severe pain. On clinical examination, The tooth was sensitive to percussion and extensive tooth decay had caused fracture of the distal part of the crown. Radiographically, no signs of periapical pathosis were observed. Local anesthesia was administered and rubber dam was applicated.

The caries lesion was removed with round bur and the missing part of the tooth was restored with composite restoration. The canal orifices were negotiated with DG-16 explorer. The access cavity was enlarged and another root canal orifice was found 

Fig. 13

The first distal canal was located towards the buccal side indicating the presence of one additional canal on the lingual side.

Fig. 14

Irrigation and sonic activation was performed.

Fig. 15

Master cone radiograph was taken, canals were dried with absorbent paper points.

Fig. 16

Obturation was performed with gutta-percha points in combination with bioceramic root canal sealer.

Fig. 17

Composite resin was used for coronal restoration, and a post-obturation radiograph was obtained.