Type I canal configuration in a single rooted maxillary first molar diagnosed with an aid of cone beam computed tomographic technique: A rare case report
A 25-year-old male patient reported to the Department of Conservative Dentistry and Endodontics with the chief complaint of severe pain in the left upper back region of the mouth since 3 days. Pain was continuous and aggravated with the intake of hot and cold beverages. Clinical examination revealed deep mesial caries approximating pulp with respect to tooth # 26. The tooth was not tender to percussion and palpation. Pulp vitality testing using an electric pulp tester (Parkell, Farmingdale, NY, USA) showed exaggerated response lasting for several minutes. Further, the maxillary lateral incisors were missing and the deciduous right maxillary first molar was overretained. Intraoral periapical radiograph of tooth # 26 revealed deep caries involving the pulp space []. Also, a single root with single canal was seen in relation to 26 and 27. Based on the clinical and radiographic findings, the diagnosis of acute irreversible pulpitis was made and patient was advised root canal treatment in relation to tooth # 26. After obtaining patient's consent, an emergency pulpotomy was performed at the same visit under local anesthesia. In order to confirm the apparent finding of the IOPA radiograph, the patient was referred for CBCT imaging of tooth 26 with 3D reconstruction. The results of the CBCT showed the presence of a single root with the Vertucci's type I canal configuration,[] and the same was observed for tooth 27 []. Thereafter, the root canal treatment was initiated. The tooth was isolated using rubber dam and access preparation was modified to completely de-roof the pulp chamber, which showed the presence of a single wide root canal orifice. Working length was calculated using an electronic apex locator (Root ZX II™, Morrita, Tokyo, Japan) as well as the radiographic method. Working length radiograph also suggested positioning of endodontic files in a single canal []. The coronal shaping was carried out using Gates Glidden burs (Dentsply, New Delhi, India) in crown down manner followed by step back technique with an apical enlargement up to size 55 K file (Dentsply) along with copious irrigation with 5% sodium hypochlorite solution. The canal was finally rinsed with 17% EDTA solution and dried with absorbent paper points (Dentsply, New Delhi, India). The root canal was obturated using a resin-based endodontic sealer (AH PLUS™; Dentsply) and laterally condensed gutta percha followed by restoration of access preparation with silver amalgam. Posttreatment radiograph showed the adequate sealing of the root canal system and the patient was asymptomatic []. The patient was advised complete coverage restoration and referred to the Department of Prosthodontics for the same.