Fig. 1

Case:  Referred 32 years old patient came to our clinic with lingering pain in her upper left area where she had an emergency access cavity done previously. we diagnosed her with irreversible pulpitis; cold testing and sensibility test was positive along with pain on percussion was also positive. A Periapical Radiographic Xray (  fig1 ) showed obvious widening in lamina dura around mesial and distal root and normal periapical tissue.

Non Surgical Root canal Treatment was decided and orthograde filling for UL7

Fig. 2

Upon inspection using Semorr Microscope, Obvious pulp chamber roof needed more troughing to expose the dentin map

Fig. 3

Diamond Cutting Ultrasonic Tip from Woodpecker (E3 D)with brushing motion in the mesial aspect to Palatal Direction was used to ensure safe deroofing .

Fig. 4

Upon insertion of 10 k File manually inside Mb2 Orifice, File took an impression of the abrupt curve present coronally which is a common state in most Mb2 canals.(Tauby et al , 2012)

Fig. 5

To Overcome This dilemma, Flexible Niti Orifice Opener Taper 5 Size 15 ( Eflex Gold from Eighteeth ) was used in rotation motion in short strokes to allow for deeper gauging beyond the coronal curve

Fig. 6

Orifices more clear, Four orifices present of all canals 

Fig. 7

After Complete Cleaning and Shaping, Merging of the Two Canals ( Mb1 and Mb2 ) Occurred in the form of coalescence .  

Fig. 8

Master Cones adjustment   

Fig. 9

Obturation was done using Warm vertical Compaction Technique with Bioceramic Sealer showing Palatal and Disto-Buccal Canal as Vertucci Type 2 ( One Apex, Two Canals )

Fig. 10

Immediate Post Operative

Video of the procedure

Fig. 11

Dr. Ingy Bahaa El Din

Passion for  Endodontics and Aesthetic Dentistry . Graduated with Bds from Future University in Egypt, 2011. Masters Degree Holder of Endodontics from Ain-shams University in Cairo, 2022. Co,owner and Head Operator of Beyond Dental Clinic in Cairo since 2015. Endodontic Specialist at EgyptAir Hospital. Conducting many One to One Endodontic Courses and Speaker in Multiple National and International Conferences. 

Conclusions

Magnification along with Counter-thinking techniques can be of great assistance to the clinician in locating Second Mesio-Buccal Canals (Pattanshetti et al , 2008).  Achieving Patency can be more of a challenge than locating the canal but with the right understanding of anatomy and how to negotiate curvatures this can be achievable. Complete cleaning and shaping of anatomical variations can lead the outcome of endodontic treatment into success as most failures occur due to missed canals (Wolcott J et al , 2005) 

Bibliography

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