Fig. 1

A Pre Opertative X-Ray show a large lesion with very bad old treatment 

Fig. 2

Starting of the procedure with rubber dam 

Removing all caries and old materials before start the cleaning and shapping of the canals 

Fig. 3

Build up the missing wall before start to make sure that all irrigation will be saved 

In the box of the access cavity 

Here we do not need to make perfect contact point because the tooth prepare for a crown 

Just rewalling the missed wall

Fig. 4

Start to remove old obturation in the mesial root and reach the apex 

Fig. 5

After cleaning the isthmus between the mesial canals and catching the middle mesial canal

Fig. 6

We notice that MMC were joined with the mesiobuccal canal and detected 

Very deep split in the distal root 

Fig. 7

After obturation by WVC technique  and cleaning the access cavity 

Fig. 8

Post op X-Ray

Conclusions

The anatomy is very important and we have to study the case very well 

CBCT can help us to detect secondary canals like MMC with the using of 

Magnification and illumination 

Bibliography

1- Zhang R, Wang H, Tian YY, et al: Use of cone-beam

computed tomography to evaluate root and canal

morphology of mandibular molars in Chinese individuals,

Int Endod J 2011;44: 990

2- Akbarzadeh N, Aminoshariae A, Khalighinejad N, et al:

The association between the anatomic landmarks of the

pulp chamber floor and the prevalence of middle mesial

canals in mandibular first molars: An in vivo analysis, J

Endod 2017;43: 1797.

3-Bansal R, Hedge S, Astekar M. Morphology and

prevalence of middle canals in the mandibular molars: a

systematic review, J Oral Maxillofac Pathol 2018;22: 216.

4-Navarro LF, Luzi A, Garcia AA, et al: Third canal in the

mesial root of permanent mandibular first molars: review

of the literature and presentation of 3 clinical reports and

2 in vitro studies, Med Oral Patol Oral Cir Bucal 2007;12:

E605.