Unusual Anatomy 3
Here’s a case that will remind you to always be on your toes! In both the straight-on and angled pre-op radiographs this seems like a “routine” lower second molar-2 roots with 2 canals in each root- no dilacerations or other “trouble”. Upon entering, I noted how wide apart the two distal canals were-something seen when the distal has developed with separate roots. After cleaning and shaping the MB and ML canals, I could see significant tissue remaining in what appeared to be an isthmus between the canals. I used ultrasonics with irrigation, copious use of NaOCl with no appreciable result. So I inserted a small hand file and it worked with light resistance down to the apex. Knowing how delicate the middle of the mesial root is and how thin the furcal side is I enlarged only to a 20/.04 and repeated the ultrasonic irrigation and copious flushing with hypochlorite. I could fit 3 paper points to length simultaneously- indicating 3 separate canals. Because of this complex anatomy, I placed CaOH paste in the canals and left it for 4 weeks before returning and obturating. Check out the post-op x-rays….