PMC8378491_01
(A and B) Preoperative radiograph of tooth 17, 16. (C and F) Working length radiographs at different angulations. (D) Magnified view of the access showing three mesial canal orifices, the fourth one (*) only faintly visible. (E) Magnified view of the access opening after CBCT evaluation and shaping showing four mesial canal orifices. (G) Master Cone radiograph. (H and I) Post-obturation radiographs at different angulations. (J-L) Radiographs after one, two, and four years of follow up, respectively
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F1
Radiograph also revealed inadequately obturated tooth 16 and full coverage extra coronal restoration [Figure 1A and B]. A soft, sticky catch between the MB 3 and MB2 created doubt for the presence of the fourth mesial canal as well [Figure 1D]. KG, Germany) and reconfirmed by periapical radiographs from different angulations [Figure 1C and F]. Canals were shaped using Hyflex CM (Coltene/Whaledent Inc., OH, USA) files up to the following sizes: MB1-25/06, MB2-25/04, MB3-25/04, MB4-25/04 [Figure 1E]. After taking a master cone radiograph [Figure 1G], the final irrigation protocol was employed. The access cavity was restored with composite resin (Filtek P 60,3M ESPE, USA) [Figure 1H and I]. A 1, 2, and 4-year follow-up radiographs [Figure 1J-L] showed normal periradicular findings.
(A and B) CBCT images of right maxillary arch showing serial axial sections at different levels. (a-F) Enlarged axial section images of tooth 17 at different levels showing Vertucci's Type XXI (4-1) pattern in the mesiobuccal root and Vertucci's TYPE III (1-2-1) pattern in the distobuccal root (white arrows). (G- J) Post-obturation CBCT Images of the enlarged axial sections of tooth 17 at different levels confirming the complete obturation of the diagnosed canal pattern (black arrows).
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F2
MB3 was present between MB2 and MB4, merging with MB4 in the middle third. MB1, MB2, and MB4 all joined together as one canal in the apical one third [Figure 2A-F]. There was one canal orifice at the floor for the DB canal, dividing into two and then reuniting again in the middle third and continuing as a single canal till the apex exhibiting Vertucci's Type III (1-2-1) pattern [Figure 2A-F]. A post obturation CBCT investigation confirmed satisfactory obturation in all the canals [Figure 2G-J].