Endodontic management of a maxillary first and second premolar with three canals
This was a case report of a of 45-year-old female patient with non-contributory medical history reported to the dental office complaining of intermittent pain in the maxillary left quadrant since 1 week. Clinical examination revealed a large amalgam restoration with secondary caries on both first and second maxillary left premolars []. The teeth were sensitive to percussion. Vitality test on both the premolars elicited no response to both cold and Electric Pulp Tester (EPT). Radiographs showed loss of lamina dura and peri apical widening in both the teeth (24 and 25).\nA diagnosis of Irreversible pulpitis with Apical Periodontitis was made and non-surgical endodontic treatment was planned for both tooth 24 and 25 followed by fixed partial denture prosthesis. Local anesthetic was administered with buccal infiltration of 1.8 ml of 2% Lignocaine with 1:200,000 epinephrine. The teeth were isolated with a rubber dam and coronal access prepared. On careful examination of the pulp chamber floor of both 24 and 25 three separate root canal orifices were identified (mesiolingual, mesiobuccal and distal). The root canals were negotiated with DG 16 explorer (Hu Freidy, USA) and ISO Size 10 files. The working length was registered with Root ZX Mini apex locater (J. Morita, Japan) which was confirmed later with radiographs [] The cleaning and shaping was done with crown down technique with Protaper Rotary instruments (Dentsply Maillefer) as per the manufacturer's instructions using 17% of ethylenediaminetetraacetic acid (Glyde, Dentsply) as lubricant and 5.2% of sodium hypochlorite as irrigant. Considering the time taken to complete the therapy, the teeth were completed in two visits. After the biomechanical preparation of both the premolars, the root canals were dried with paper points and a paste of calcium hydroxide (Ultracal, Ultradent USA) was used as intracanal medication. A provisional restoration of Cavit (3M ESPE) was placed between visits. At the second appointment, the patient was completely asymptomatic. The root canals of both the teeth were once again flushed with 5.2% sodium hypochlorite and the canals were dried. The master cone radiograph was taken [] and the root canals were then obturated using F2 Protaper Gutta-percha (Dentsply Maillefer) using AH plus resin sealer (Dentsply, Detrey) and post obturation radiograph was taken [].\nThe orifice was then sealed with Flowable composite (Ivoclar Vivadent) and the access cavity was then restored using SureFil composite resin (Dentsply).\nThe 1 year follow-up radiographs with two angulations was taken to clearly identify the canals [Figure and ].