Fig. 1

A 33 years old female presented to my clinic complaining from lower left quadrant pain, the patient was generally fit.

On intra-oral examination the lower left 1St premolar was tender to percussion.

Periapical radiograph showed endodontically treated 1St premolar with periapical radiolucency.

Endodontic retreatment started immediately.

Fig. 2

the CBCT scan showed the presence of three root canals

Fig. 3

Rubber dam isolation

Fig. 4

Mechanical removal of gutta percha by 25%06  rotary file with NaOCl 5.25% irrigation.

To gain sufficient access to the canals, the access was modified using ultrasonic tips acteon ET18 D.

Fig. 5

Location the canals, Then instrumentation done by 20%0.4 then 25%0.4 with NaOCl 5.25% .

Fig. 6

Obturating the canals till the level of the canal orifices

Fig. 7

Backfill the canal (middle and coronal)

Fig. 8


Fig. 9

Post operative X-ray (left) and 1 year follow up (right)

Fig. 10

Graduated 2011 from Hawler medical university
Long term (5 modules ) Advance endodontic course 2018 .
Best case of the year 2021 from style italiano endodontics .
Fellow member of style italiano endodontics 2023 .


 It is absolutely essential for an operator to form a mental picture of the pulp chamber in cross section & from the coronal aspect to the apical foramina. 

Each canal may contain irregular & hidden configuration that should be taken into account during endodontic treatment. 

Instruments must access these hidden regions and clean & shape them as maximally as possible to avoid or minimize treatment failure.


1-Zillich R, Dowson J. Root canal morphology of mandibular first and second premolars.Oral surg Oral Med Oral Patho.1973;36:738-44.

2-Ingle JI, Beveridge E,Glick D D,Weichman J. Ingle JI, Taintor JF, editors. The Washington study. Endodontics, Philadelphia.1994:1-53.Lea and Fabiger.

3-Vertucci FJ. Root canal morphology and its relationship to endodontic procedures.Endod Top.2005;10:3-29.