engleski

Root canal treatment of a three-rooted mandibular first molar: a case report

INTRODUCTION: The success of endodontic treatment depends on the eradication of microorganisms from the root canal system and prevention of re-infection. Variability of root canal morphology is often a complicating factor in a successful root canal treatment. It is known that the mandibular first molar can display significant anatomical variations namely the number and morphology of roots and root canal systems. This case report describes the management of mandibular first molar with a distolingual third root ( Radix Entomolaris). INITIAL STATE: A 29-year-old male patient reported to the Dental clinic, Department of Conservative Dentistry and Endodontics, with the chief complaint of moderate and intermitent pain of the right mandibular first molar for the past month. Clinical examination revealed a deep carious lesion on the distal part of the crown. A preoperative radiograph revealed secondary caries approaching the pulp space and a widening of the periodontal ligament space relative to the mesial and distal root. Additional distolingual root was also visible on the periapical radiograph (Fig. 1). DIAGNOSIS: Based on the present findings, a diagnosis of chronic apical periodontitis was established. TREATMENT PROCESS: During the first session, after caries removal, the endodontic access cavity was prepared under rubber dam isolation. The access cavity was modified from the conventional triangular to trapezoidal shape in order to locate the distolingual root canal orifice (Fig. 2). The working lengths were determined by means of an electronic apex locator (Endometar ES-02, Artronic, Zagreb, Croatia) and confirmed radiographically with size 15 K-files in place. The canals were irrigated with 2.5% sodium hypochlorite. The root canal treatment was performed with ProTaper Universal rotary instruments (Dentsply, Maillefer, Ballaigues, Switzerland) in crown-down technique after which a dressing of calcium hydroxide paste was placed. The patient was recalled 7 days later. The canals were obturated with ProTaper Universal gutta-percha single cones (Dentsply Maillefer) and AH Plus resin sealer (Dentsply Maillefer). (Fig. 3). RESULTS: 1 year after root canal treatment, the patient was asymptomatic. The response to percussion and palpation was within normal limits. The radiographic examination revealed periodontal bone repair with no signs of periodontal lesion (Fig. 4). RECOMMENDATIONS: This case indicates that the clinicians have to be aware of complex and variable root canal morphology since it is essential to clean and disinfect all areas that may harbor microorganisms or necrotic pulp tissue which can induce further apical pathosis

root canal morphology; mandibular first molar

nije evidentirano