Complex Apical Anatomy Discovered Following Minimal Endodontics

History & Diagnosis

A fourty-four-year-old female presented with biting pressure. The patient had a history of hypertension. All other medical history was unremarkable. Upon clinical examination, the maxillary right second molar (#2) showed no sensitivity to percussion or palpation although the patient reported a pain level of 3 on a 10-point pain scale. Sensitivity testing with cold water and a monojet 42 syringe revealed an immediate response. After complete clinical and radiographic examination, a diagnosis of symptomatic irreversible pulpitis with symptomatic apical periodontitis was made.

GentleWave® Procedure

The patient was anesthetized and the tooth was isolated with a rubber dam. A conservative endodontic access was completed and four distinct canals were visualized: palatal, distobuccal, mesiobuccal and mesiobuccal-2. No orifice openers were utilized to maximize dentin preservation. Minimal instrumentation was accomplished by shaping the canals to size 25/.04 with EdgeFile^® rotary files. The GentleWave^® Procedure was then completed to remove pulp tissue remnants, debris, smear layer and bacteria. All root canals were obturated using a warm vertical compaction technique with gutta-percha and AH Plus® Sealer. Upon post-operative radiographic examination, multiple lateral canals within the apical third of the palatal and distobuccal canals as well as an isthmus between the mesiobuccal canals were visualized. Upon contact with the patient three days post-operative, the patient reported no discomfort.