Fig. 1

Clinical data

Tooth 36

Dg: Pulpitis acute irreversible

Treatment plan :

Root canal treatment


Fig. 2

Pre operative X-ray 

Fig. 3

Isolation, initial preparation of endodontic access cavity 

Fig. 4

Detection of confluence in artificial tooth to illustrate the procedure

First we need to put the gutta-percha in the main canal, then with manual instrument ISO 08 or 10 we go into the other canal, in order to detect the level of confluences.

Fig. 5

In the gutta-percha will remain some scratches from the instrument, and this confirms the presence of confluences and determines their level

Fig. 6

The tooth is ready for obturation after all endodontic procedures

Fig. 7


Warm vertical technique

Fig. 8

X-ray after obturation

Fig. 9

Crown cementation

Fig. 10

X-ray after Crown cementation


Pre-treatment case evaluation greatly facilitates our work and avoids any errors that may occur during treatment. 

Applying methods for detecting the confluences in this cases are inevitable.

If we have a pre-treatment plane, it will reduce the possibility of mistakes and surprises that may occur during the treatment. 


Vertucci Fj. Root canal morphology and its relationship to endodontic procedures, Endodontic topics,2005

Arnaldo Castellucci , Two canals in a single root: clinical and practical considerations, 2003

Furri,M , Differences in the confluence of mesial canals in mandibular molar with three or four root canals, International endodontic journal, 2008

Gianluca Gambarini et AL. Cone-beam computed tomographic analysis on root and canal morphology of mandibular first permanent molar among multiracial population in Western European population, European Journal of Dentistry, 2018