PMC7315308_01
Panoramic radiograph of presenting patient confirms the lack of symmetry between single-rooted tooth #47 and contralateral tooth #37 which presents with two distinct roots.
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Radiographic assessment commenced by systematic evaluation of the already available panoramic radiograph (Figure 1).
Preoperative radiographic assessment. (a) Straight-on and (b) angulated initial radiographs showing tooth #47 with deep occluso-mesial caries along with large pulp space situated within a single conical root. (c, d) Sagittal and coronal CBCT slices suggest the presence of one root canal configuration. (e-g) Further evaluation of the axial cuts in the coronal, middle, and apical thirds confirms the presence of Vertucci Type I canal system.
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The obtained preoperative periapical radiographs (Figures 2(a) and 2(b)) demonstrated the presence of one large canal along with one conical root and slight widening of the periodontal ligament space around the apex of tooth #47. Finland) was obtained in order to enable three-dimensional assessment of pulp space morphology. Further evaluation of sagittal, coronal, and axial slices confirmed the presence of one large round-oval canal extending from the orifice level to the root apex without any evidence of additional canals (Figures 2(a)-2(g)).
(a) Accessed cavity preparation shows the presence of one large root canal located in the center of the pulp chamber. (b) Working length determination radiograph. (c) Master gutta-percha cone radiograph. (d) Final radiograph showing dense obturation with sealer puffs.
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The dental operating microscope (OPMI Pico, Carl Zeiss Surgical, Oberkochen, Germany) showed the presence of a large round canal orifice located in the center of the pulp chamber floor (Figure 3(a)). Working length (WL) was determined using a size 20 K file attached to an electronic apex locator and then confirmed using a digital radiograph (Figure 3(b)). The snug fit of a size 40, taper 0.06 master gutta-percha cone was evaluated radiographically (Figure 3(c)). The canal was then obturated with gutta-percha cone and AH26 sealer (Dentsply Maillefer) using a hybrid technique combing cold lateral and warm vertical compaction techniques (Figure 3(d)).