PMC6556251_01
(a) Panoramic radiograph of the referred patient. (b) Bitewing view of the interesting tooth, which showed a deep carious lesion. (c) X-ray after the first endodontic treatment. In the distal roots, two root fillings are visible, whereas only one filled root canal can be identified in the mesial roots. Note two mesial roots. Buccal: dotted line; palatal: scored line.
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Together with the referral, the radiographic history of the relevant tooth was provided (Figures 1(a)-1(c)). But the X-ray image after the first endodontic treatment was taken mesial angulated, and here, a second previously untreated mesial root is visible (Figure 1(c)).
(a) The pretreatment radiograph showed an apical radiolucency on the mesial root. Due to the buccal-palatal superimposition, the second mesial root is not visible. (b) Photograph of the pulp chamber floor after removal of the gutta-percha. Root canal orifices were "irregular quadrilateral" shaped on the pulp chamber floor representing Versiani Type A. (c) Photograph after the canal obturation. (d) The posttreatment radiograph showed two mesial filled root canals (arrows).
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fig2
This straight radiographic evaluation of the examined tooth revealed no unusual anatomy (Figure 2(a)). Two weeks later, the canals were reentered and Ca(OH)2 was removed by using 2.5% NaOCl, 2% CHX, and 18% EDTA and obturated with appropriate gutta-percha mastercones (ISO 40, VDW, Munich, Germany) along with an AH plus sealer (Dentsply DeTrey, Konstanz, Germany) using the lateral condensation technique (Figure 2(c)). The postendodontic radiograph demonstrated two mesial-located apices (Figure 2(d)).
Cone beam computed tomographic 3D reconstruction of the treated tooth from a disto-buccal-apico angulation verifies the rare anatomy of four roots. MB: mesiobuccal; DB: distobuccal; MP: mesiopalatal; DP: distopalatal.
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To verify this rare anatomy, a 3D cone beam computed tomography (CBCT) (KaVo OP 3D DVT, KaVo Dental, Biberach an der Ribeta, Germany) was performed and analyzed (Figure 3). The patient gave his informed consent for the publication of this communication.