Endodontic Management In Mandibular Left First Molar With Seven Canals

This case report presents an endodontic management of mandibular first molar with seven canals, accompanied by a periapical abscess. A 42-year-old female patient complained of pain upon biting in the left posterior mandible for three days. Past dental history revealed "dental treatment" and crown restoration 20 years ago. Three days prior, the patient experienced severe pain, leading to crown removal and attempted root canal treatment (RCT), but referral was sought due to "canal obstruction." Examination:Tooth 36 had a prepared crown, percussion (+++), no mobility. Radiograph: Periapical radiolucency in the mesial root with unclear canal outlines. Diagnosis: 36 acute apical abscess. Treatment Plan: Microscopic RCT + crown restoration. Procedure: - Isolation with rubber dam. - Pre-curved small files bypassed ledges, negotiating canals to the apex. - Canals were shaped up to F2 using ProTaper Gold (Dentsply, Switzerland). - Persistent clear exudate after preparation led to a 1-hour pause; due to unresolved symptoms, the tooth was left open for 24 hours with a CBCT referral. - Microscopic RCT with 3% NaOCl irrigation, ultrasonic activation, Ca(OH)₂ dressing, and temp seal. - Recall obturation revealed suspected missed canal. CBCT obtained, canal re-prepared and filled. - Radiograph showed slight sealer extrusion. Unclear canal outlines on radiographs warrant suspicion of additional canals, necessitating CBCT for diagnosis. Leaving the pulp open may complicate infections; strict indications are crucial. Mastering root canal anatomy is crucial for success. CBCT and microscopes boost treatment outcomes.