Dr. Nishant S. Gandhi

-A 35-year-old male patient reported to the dental office with complaints of pain on chewing in right posterior tooth.
-On clinical examination, there was a gross decay in mandibular right first permanent molar (46).
-Tooth was tender on percussion. Radio graphically the presence of widened periodontal ligament space  (PDL) in the mesial roots and the presence of a third root between the mesial and distal roots were evident.
The condition was diagnosed as chronic periapical periodontitis and the treatment plan was endodontic therapy followed by full coverage restoration.


-Inferior alveolar  and lingual nerve block administered
-Rubber dam placed
-Access cavity preparation done
Straight line access  using Gates Glidden No.1 & 2

-Cleaning & shaping of the root canal    using No.10 & 15 K-file to the full working length.
-Followed by Protaper rotary shaping files – S1, S2 & finished with F1.
-Sodium hypochlorite used as disinfectant of root canal system.

-Obturation  done with F1 Protaper gutta percha cones and AH plus sealer.

Temporary cementation followed by permanent composite restoration.

The success of endodontic therapy depends on the root canal morphology to some extent.  Morpho-anatomic changes in teeth may be divided according to the site of their occurrence; i.e., tooth crown, roots and root canals.
Clinicians should be aware of these unusual root morphologies in the mandibular first molars in
Indian population. The initial diagnosis of a radix entomolaris or paramolaris before root canal
treatment is important to facilitate the endodontic procedure, and to avoid ‘missed’ canals