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ePaper created 2015-05-29, 13:18:43 | version 1.38.0
I case report _ CBCT in diagnosis was left in the pulp chamber and the cavity was then sealed with a temporary filling material. In the second session, two weeks later, the DP and DB root canals were carefully prepared, applying the sameWaveOnetechniqueasusedfortheMPandMB root canals: the DP canal with WaveOne black (#40) and the DB canal with WaveOne red (#25). The work- ing length was determined and checked using the same electronic apex locator. Throughout the entire endodontic procedure, 2.2 % sodium hypochlorite and 10 % citric acid so- lutions were used as irrigants, successively, in all four root canals. Each of the four canals was finally irri- gatedwith40mlofa2.2%NaOClsolution,driedand obturated using Acroseal (Septodont) and a single gutta-percha cone with an adequate taper (DENTS- PLY Maillefer; Fig. 3). Theintra-oral,retro-alveolarradiographcaptured post-treatment was of relatively poor quality owing to superimposition and interference of the infra- zygomatic arch and adjacent bone structures, and failed to show the most important apical portions of the roots with the correct root canal fillings (Fig. 4). Inagreementwiththepatient,aCBCTscanwasob- tained,primarilytocheckthetreatmentoutcome,but also to document this extremely rare case with much more accurate and reliable images. The small field of view (50 x 50mm) was recommended, and the data was acquired by SCANORA 3Dx (SOREDEX) immedi- ately after the treatment and at the six-month recall. The edited images (OnDemand3D, Cybermed) clearlyvisualizedtwodistinctivepalatalroots,theirre- lation to the two buccal roots, the adjacent anatomic structures and, most importantly, the quality of the obturation of all four root canals (Figs. 5–9, arrows). _Conclusion and key learning points Acarefulassessmentoftheinternalanatomyofthe pulpchamberisessentialfordetectingallrootcanals. Amaxillarysecondmolarwithtwoseparatepalatal roots is a rare anatomical variation and, according to our records, is detected only once in a decade. CBCT images provide more accurate and reliable information regarding roots and the root canal mor- phology than conventional radiographs are able to provide.Furthermore,concerningthetreatmentout- come, CBCT images enable a much more predictable and successful endodontic treatment procedure._ Editorialnote:Thisarticleisbasedontheworkpresentedat the16th congressoftheEuropeanSocietyofEndodontology inLisboninPortugalin2013. Figs. 8 & 9_PAN detail, volume-rendered view and Multi-Planar Reformat view of treatment check-up of tooth #27. 28 I cone beam2_2015 Ass.Prof.Katarina Beljic-Ivanovic is an assistant professor at the Department of Restorative Odontology and Endodontics at the Faculty of Dental Medicine of the University of Belgrade in Serbia. cone beam_author Fig. 8 Fig. 9