Marcia da Silva Schimtz, Claudia M L Pagliarin, Aline Londero, Francisco Montagner, Renata Morgental


Knowledge of possible morphological variations of the root canal system is crucial to achieve endodontic success. The radiographic apex is traditionally used as a reference point for establishing the apical limit of root canal instrumentation and obturation. However, frequently it does not coincide with the major apical foramen. This article describes the rare case of a mandibular molar with necrotic pulp and apical periodontitis exhibiting an unusual foraminal position with a distance from the radiographic apex of about 7 mm. The left mandibular molar of a 46-year-old female patient was referred for endodontic treatment. Following radiographic suspicion of apical calcifi cation, comparison with the mandibular molar on the opposite side, electronic working length determination and visualization of a size #15 fi le emerging through the foramen in the working length radiograph, the anatomical variation was confi rmed, and endodontic procedures were performed according to conventional techniques. Following chemomechanical preparation, intracanal medication with calcium hydroxide, and obturation, total regression of the periapical lesion was verifi ed after 7 years of follow-up. According to the literature, the distance between the root canal foramen and the root apex may range from 0 to 3 mm, but in this specifi c case the distance reached 7 mm. Dentists should be aware of this atypical anatomical situation when treating mandibular molars.

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