PMC3916505_01
(a) Preoperative radiograph showing the external outlines of the two mesial roots (white arrows); (b) Working length radiograph showing three separate roots and root canals; (c) Master cone radiograph; (d) Post-obturation radiograph.
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F1
The preoperative diagnostic radiograph showed carious lesion closely approximating the pulp with no signs of periapical changes (Figure 1a). Radiographic evaluation of the involved tooth revealed an unusual anatomical configuration suggesting the possibility of the presence of two mesial roots (Figure 1a). Tulsa, OK, USA). The working length was initially determined with the help of an apex locator (Raypex5, VDW, Munich, Germany) and confirmed using radiographs taken at different horizontal angulations. The working length radiographs showed three independent root canals in three separated roots (Figure 1b). Master cones were selected by placing cones corresponding to the size of the last finishing file used to the working length and was confirmed radiographically (Figure 1c). Final radiograph was taken to establish the quality of the obturation (Figure 1d).
An intraoral photograph showing the wide buccolingual dimension of the mesial orifices.
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F2
On inspection with a DG-16 endodontic explorer (Hu-Friedy, Chicago, IL, USA) under an operating microscope (Roslane Meditech, Haryana, India), the pulp chamber floor revealed three canal openings corresponding to the two mesial and one distal roots (Figure 2).
(a) Transverse section cone-beam computed tomography (CBCT) scan image of tooth #47 clearly showing two separate mesial roots. Axial section of CBCT scan image (b) at the coronal third; (c) at the middle third; (d) at the apical third.
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F3
The involved tooth was focused, and the cross-sectional images were obtained in transverse, axial, and sagittal planes (Figures 3a - 3d). Horizontal slices of the molar were obtained at 0.5-mm thickness, and were studied at different levels (coronal, middle, and apical third of the roots) to determine the level of root bifurcation and degree of root separation (Figures 3b - 3d). It had 2 roots, 1 mesial, and 1 distal with 2 canals in the mesial root and 1 canal in the distal root (Figures 3a - 3d).