Endodontic management of four rooted mandibular first premolar
A 24-year-old male patient came to a private dental clinic with pain in the left lower back tooth. On intraoral clinical examination, there was a decayed 34. An intraoral periapical radiograph was advised. On radiographic examination preoperative radiograph revealed radiolucency involving pulp with respect to 34 []. Diagnosis of acute irreversible pulpitis was made. Also IOPA revealed 34 having four roots. To confirm the presence of four roots two more radiographs one with distal angulation and the other with mesial angulation were taken [Figure , and ]. Access was gained to the pulp chamber after administration of local anesthesia (2% Lignocaine with 1:100000 epinephrine), under rubber dam isolation. To gain sufficient access to the canals, the conventional access opening was modified into one that was wider. Orifice location was not easy as the coronal pulp chamber was unusually long. After careful inspection, four canal orifices were located and patency was ascertained using a small size K-file (Kerr, Orange, California). Mesiobuccal, distobuccal, mesiolingual, and distolingual canals were identified. Working length was established with the use of apex locator (Root ZX, J. Morita Inc.) Then the working length radiograph was taken and measured ].\nThe canals were cleaned and shaped with hand K-files and nickel titanium rotary ProTaper files (Dentsply Maillefer, Switzerland). The canals were sequentially irrigated using 5.25% Sodium hypochlorite and 17% EDTA during the cleaning and shaping procedure. The canals were thoroughly dried and obturation was done using F2 Pro Taper Gutta-percha and AH Plus sealer (Dentsply, Maillefer, Switzerland).\nThe post-endodontic permanent restoration was completed with composite (3M ESPE Dental Products, St Paul, MN) []. The patient was reviewed after a month and was found to be asymptomatic. A 1-year recall radiograph showed satisfactory healing and was advised to get this tooth crowned [].