Tooth- and Patient-Related Conditions May Influence Root Canal Treatment Indication.

AIM: To investigate predisposing aspects related to the indication for root canal treatment (RCT) at Dental Schools of Brazil. METHODS: Data of 207 patients referred to endodontic treatment at undergraduate Dental Schools of Brazil were collected over a period of 8 months. Patient-related data included age, gender, first dental visit, tooth brushing frequency, number of remaining teeth, and previous endodontic treatment, and tooth-related information regarding number, type, and location in the mouth of teeth that need RCT, waiting time for the endodontic treatment, endodontic diagnosis, pain report, and dental crown condition was collected for each participant. Bivariate analysis (Chi-square test; p < 0.05) associated gender and tooth/patient-related conditions. Poisson regression analysis compared multiple endodontic need and exposure variables. RESULTS: Patients were mainly comprised of women (65.2%), aged 18-39 years (69.6%). Previous RCT was significantly more prevalent in women when compared to men (p=0.005). First dental visit at later moment (after 20 years of age) demonstrated 400% greater prevalence of multiple RCT demand when compared to patients that attended the dental office at age below seven years (p=0.032). Most of the patients presented only one tooth needing RCT (80.2%), mainly premolars (44.9%). Interestingly, women underwent more RCT in maxillary teeth (p=0.016) and significantly contributed with their report to the diagnosis process when compared to men (p=0.014). Regarding dental crown condition, 45.4% of all teeth registered unsatisfactory restorations, which were more pronounced in female patients (p=0.018). Unsatisfactory restorations or dental caries had 75% and 82%, respectively, less prevalence of multiple RCT indication when compared to sound dental crown (p=0.001). CONCLUSIONS: RCT was undertaken more frequently in young female adults' premolars presenting unsatisfactory restorations. First dental visit, number of teeth with previous endodontic treatment, tooth group, and dental crown condition were significantly associated with the necessity of multiple endodontic treatments.

Pré-molar com três raízes tratado por meio de Endodontia convencional: relato de caso com acompanhamento de 24 meses / Three-rooted premolar treated with conventional endodontics: 24-month follow-up case report

O completo conhecimento da anatomia dentária interna representa um dos fatores determinantes para o sucesso do tratamento endodôntico. A presença de três raízes em segundos pré-molares superiores refere-se a uma ocorrência rara durante os tratamentos endodônticos convencionais, tornando-se relevante sua descrição detalhada na literatura. Objetivo: O presente trabalho objetiva descrever o tratamento endodôntico de um segundo pré-molar superior apresentando três raízes separadas. Relato de caso: O paciente atendido compareceu para atendimento relatando dor contínua e exacerbada ao frio, em seu segundo pré-molar superior direito. O exame radiográfico sugeriu a presença de três raízes separadas no referido pré-molar, o que foi confirmado durante a abertura coronária, que foi realizada de forma cuidadosa. Os canais foram instrumentados por meio da técnica manual de pre- paro químico-mecânico e obturados por meio da técnica de compactação lateral. Os controles aos 12 e 24 meses não demonstraram alteração clínica e radiográfica. Conclusão: A presença de três canais radiculares em segundos pré-molares superiores pode comprometer o sucesso do tratamento endodôntico. Entretanto, o conhecimento adequado da anatomia e do diagnóstico pode possibilitar o tratamento de variações anatômicas por um clínico geral sem o emprego de recursos tecnológicos (AU).

Introduction: The thorough knowledge of the internal anatomy of tooth is one of the determining factors for the success of endodontic treatment. Three-rooted second maxillary premolars represent a rare occurrence during endodontic treatment, making its description in the literature an important contribution. This paper describes the endodontic treatment of maxillary second premolar with three separated root canals. Case report: The patient exhibited a right maxillary second premolar affected by continuous pain that was exacerbated by cold testing. Periapical radiograph analysis suggested the presence of three separated roots, which was confirmed during the careful access to the pulp chamber. The tooth was treated with manual instrumentation technique and filled through lateral condensation technique. One and two-years follow-up visits revealed absence of clinical and radiographic signals. Conclusion: The presence of three root canals in second maxillary premolars may compromise endodontic treatment success. Meanwhile, a conscious knowledge of anatomy and a careful diagnosis do not exclude the treatment of anatomic variations by a general dentist without the use of technological resources (AU).

Tratamento alternativo para dentes traumatizados com reabsorção radicular inflamatória: 4 anos de acompanhamento / Alternative treatment for traumatized teeth with inflammatory root resorption: 4 years follow-up / Tratamiento alternativo para dientes traumatizados con reabsorción radicular inflamatoria: 4 años de seguimiento

Objetivo: Este relato descreve o tratamento de um incisivo central superior previamente traumatizado, afetado pela reabsorção radicular inflamatória interna / externa. Método: Trata-se do relato de caso de um paciente com 12 anos de idade que relatou um trauma de queda um ano antes da consulta, causando fratura da coroa e luxação intrusiva no incisivo central superior direito. Os exames clínicos verificaram sensibilidade à percussão e descoloração da coroa. Radiograficamente, as áreas radiolúcidas sugeriram reabsorção radicular inflamatória (no terço da raiz cervical) e lesão periapical. Resultados: O tratamento endodôntico foi realizado, com uma pasta de hidróxido de cálcio com paramonoclorofenol canforado inserida no canal radicular por 2 meses. Quando uma barreira calcificada na área apical foi observada radiograficamente, toda a raiz foi obturada com agregado de trióxido mineral (MTA). O dente foi acompanhado por 4 anos, mostrando regressão dos sintomas, cicatrização por reabsorção e também aumento no comprimento radicular. Conclusão: O presente caso mostrou que o tratamento endodôntico associado ao MTA promoveu a remodelação óssea da área periapical e paralisou a reabsorção.

Objective: This report describes the treatment of a previously traumatized central central incisor affected by internal/external inflammatory root resorption. Method: This is the case report of a 12-year-old patient who reported a fall trauma one year before the consultation, causing crown fracture and intrusive dislocation in the right upper central incisor. Clinical examinations verified sensitivity to percussion and discoloration of the crown. Radiographically, radiolucent areas suggested inflammatory root resorption (in the third of the cervical root) and periapical lesion. Results: Endodontic treatment was performed with a calcium hydroxide paste with canouted paramonochlorophenol inserted into the root canal for 2 months. When a calcified barrier in the apical area was observed radiographically, the entire root was computed with mineral trioxide aggregate (MTA). The tooth was followed for 4 years, showing regression of symptoms, healing by resorption and also increase in root length. Conclusion: The present case showed that endodontic treatment associated with MTA promoted bone remodeling of the periapical area and paralyzed resorption.

Objetivo: Este informe describe el tratamiento de un incisivo central central previamente traumatizado afectado por la resorción de raíz inflamatoria interna/externa. Método: Este es el informe del caso de un paciente de 12 años que reportó un trauma de caída un año antes de la consulta, causando fractura de corona y dislocación intrusiva en el incisivo central superior derecho. Los exámenes clínicos verificaron la sensibilidad a la percusión y la decoloración de la corona. Radiográficamente, las áreas radiolúcidas sugirieron resorción inflamatoria de la raíz (en la tercera de la raíz cervical) y lesión periapical. Resultados: El tratamiento endodóntico se realizó con una pasta de hidróxido de calcio con paramonoclorofenol canouted insertado en el conducto radicular durante 2 meses. Cuando se observó radiográficamente una barrera calcificada en el área apical, toda la raíz se calculó con el agregado de trióxido mineral (MTA). El diente fue seguido durante 4 años, mostrando regresión de los síntomas, curación por resorción y también aumento en la longitud de la raíz. Conclusión: El presente caso mostró que el tratamiento endodóntico asociado con la MTA promovía la remodelación ósea de la zona periapical y la resorción paralizada.

Endodontic Tendencies in a Very-Low-Income Population Area of Northeastern Brazil.

AIM: To gather information regarding endodontic treatment protocols and continuing education attendance of dentists in some cities located in Northeastern Brazil (Sergipe and Bahia States), a region that comprises a very-low-income population. METHODS: A questionnaire containing different questions (e.g., routine treatment protocols, the use of new technologies, time required to conclude the treatment, and attendance in an endodontic continuing education) was distributed to 250 dentists. The collected data were analyzed through descriptive statistics and Poisson regression (p < 0.05). RESULTS: A total of 199 dentists practicing endodontic treatment in the cities of Aracaju (n = 58), Salvador (n = 83), and towns of Estância (n = 8), Itabaiana (n = 16), Itabaianinha (n = 5), Lagarto (n = 10), Ribeirópolis (n = 3), Simão Dias (n = 6), and Tobias Barreto (n = 10) participated in this research. Most of the respondents have concluded their graduation in Dentistry in less than 10 years (62.3%), with nearly 75.4% of the sample having attended postgraduation education in the field. Regarding treatment protocols, the frequency for using rotary/reciprocating systems and for always using rubber dam isolation during root canal treatment (RCT) was 78% and 62%, respectively, which was also more prevalent among dentists who attended a continuous education program (p < 0.05). Lastly, the professionals who attended (p < 0.05) to a continuous education program in Endodontics were more frequently associated to performing incisors and molars RCT in one clinical appointment (p < 0.05). CONCLUSIONS: The results of this survey indicated that even in an area where most of the population has low-income conditions, the professionals are seeking for knowledge by attending to postgraduation programs, following the new tendencies in Endodontics with most of the professionals having employed technological resources.

Dental trauma education intervention as a positive influence among undergraduate students.

OBJECTIVE: To investigate the effect of dental trauma educational intervention among undergraduate students of a Federal University in Brazil. MATERIALS AND METHODS: Students (n = 125) enrolled in the dentistry (n = 70), nursing (n = 33), and speech therapy (n = 22) courses were invited to attend a dental trauma lecture and also to answer a questionnaire about their confidence in managing crown fracture and tooth avulsion, before (T0) and immediately after (T1) the lecture. McNemar's test (P < 0.05) with logistic regression compared the answers between the courses. RESULTS: Female gender (78.4%) aged from 18 to 22 years (73.6%) predominated among all the participants. Dentistry students scored higher correct answers (54.3%) in T0 when compared to nursing (12%) and speech therapy (9%) students, concerning the storage medium for tooth fragment transportation. Likewise, few dentistry students (22.9%) and no nursing and speech therapy students knew about the ideal storage medium for an avulsed tooth when immediate replantation was unviable. After educational intervention, a significant improvement was found between T0 and T1 (P < 0.001) for all courses, mainly regarding tooth avulsion with almost 100% of correct answers. Furthermore, logistic regression demonstrated that dentistry students had three times more knowledge absorption than nursing and speech therapy ones. CONCLUSIONS: The educational intervention demonstrated a significant positive impact regarding the knowledge of dental trauma emergency management among health students. Accordingly, it is essential to spread this information among health professionals to save teeth, especially in cases of avulsion.

Fracture resistance of weakened bovine teeth after long-term use of calcium hydroxide.

BACKGROUND/AIM: In some parts of the world, revascularization may not be the most feasible treatment option for necrotic immature teeth. Therefore, apexification remains the most widely utilized treatment option for these cases. This study aimed to evaluate the fracture resistance of weakened bovine tooth roots treated with various irrigant solutions as well as long-term application of calcium hydroxide intracanal medication (ICM). MATERIAL AND METHODS: One hundred seventy bovine teeth were randomly divided into three experimental groups (n = 50) and two control groups (n = 10). Group SS was irrigated with physiologic solution; group CHX was treated with 2% chlorhexidine gel and group NaOCl was irrigated with 1% sodium hypochlorite. After instrumentation, root canals were dressed with calcium hydroxide and evaluated at different periods (15, 60, 90, 180, and 360 days). The specimens were loaded at a 45° angle to measure fracture resistance through the use of an EMIC test machine. RESULTS: A decrease in fracture resistance was observed during the time of ICM dressing. The highest values of fracture resistance were observed in group SS with 15 days of ICM, not differing from the control group. Irrigation with NaOCl associated with ICM for 15 days presented the lowest fracture resistance; however, a statistically significant difference was not observed when compared with SS and CHX in the same time period. In longer periods of exposure to ICM (180 and 360 days), root canals irrigated with NaOCl and CHX showed significantly lower fracture resistance than SS (P < 0.05). CONCLUSION: Apexification with periodic changes of calcium hydroxide medicament leads to weakness of the teeth independent of the irrigation solution used.

Pulp revascularization: an alternative treatment to the apexification of immature teeth / Revascularização pulpar: tratamento alternativo à apicificação de dentes jovens com rizogênese incompleta

Pulp revascularization can be considered as a current alternative treatment to apexification, recommended for immature teeth cases, requiring endodontic treatment. Apexification involves long-term periodic exchanges of a calcium hydroxide paste into the root canal to induce the formation of a calcified barrier. Despite being the most classically therapy employed for these cases, the permanence of calcium hydroxide for long periods of time and also the successive changes may lead to a weakening of the root due to its hygroscopic properties and the proteolytic activities of calcium hydroxide, increasing the risk of fractures and contamination of the pulp space. Thus, a constant search for new treatment alternatives that provide the end of root development have been done to avoid the risk of future root fractures. So, revascularization has emerged as a new treatment option for cases of undeveloped teeth, that provides not only apical closure, as apexification, but also increase the dentin walls thickness. In the literature, there is an assortment of treatment protocols employing pulp revascularization procedure in attempt to attain the best way to achieve success. Assuming the diversity of protocols for revascularization treatment, it is important to go deep in the literature to collect, describe and discuss these protocols guiding new researches in this field and also conducting the clinicians. Therefore, this review aims to assess the literature on the different revascularization protocols.

A revascularização pulpar pode ser considerada atualmente como um tratamento alternativo à apicificação e é indicado para dentes com rizogênese incompleta e necessidade de tratamento endodôntico. A apicificação envolve a realização de trocas periódicas em longo prazo de uma pasta de hidróxido de cálcio com o objetivo de formar uma barreira calcificada. Apesar de ser a terapia mais empregada, a permanência desta medicação por longos períodos e as trocas sucessivas, podem levar à fragilização da raiz devido às propriedades higroscópicas e proteolíticas do hidróxido de cálcio, aumentando o risco de fraturas e contaminação do espaço pulpar. Desta forma, tem-se buscado novas alternativas de tratamento que possibilitem o fechamento do forame apical dos dentes imaturos sem que ocorra a fragilização dos mesmos. A revascularização pulpar tem surgido como uma nova opção de tratamento para estimular o término do desenvolvimento radicular e não apenas o fechamento apical. Há na literatura uma variedade de protocolos utilizando esta técnica, buscando sempre alcançar o sucesso no tratamento. Diante dessa variedade, é de grande importância a realização de uma revisão de literatura sobre revascularização pulpar visando reunir, descrever e discutir os diferentes protocolos, para que possam direcionar novas pesquisas e ser empregada de forma adequada pelo clínico. O objetivo desse trabalho é revisar na literatura os diferentes protocolos de revascularização pulpar.

Novel in vitro methodology for induction of Enterococcus faecalis biofilm on apical resorption areas.

CONTEXT: Teeth with periapical lesion usually present external root resorption around the apical foramen. These areas facilitate adhesion and co-aggregation of microorganisms developing biofilms. Up to the present moment, there is no methodology in the literature that enables the in vitro evaluation of endodontic irrigants and intracanal dressings on biofilms located in apical external root resorptions of human teeth. AIMS: This study aimed to describe a new in vitro methodology for Enterococcus faecalis biofilm development in external apical reportion areas of human extracted teeth in different periods of time. SETTINGS AND DESIGN: In vitro qualitative laboratory study. SUBJECTS AND METHODS: Thirty roots from human extracted teeth presenting external apical resorption had their root canal diameters standardized by means of instrumentation. Next, the roots were randomly divided into three groups (n = 30) according to E. faecalis strains (ATCC 29212) exposure time as follows: Group T5, with 5-day exposure; Group T10, with 10-day exposure, and Group T15, with 15-day exposure. The roots were attached to 24-well culture plates so that only their apices could be in contact with bacteria for induction of biofilm formation. At the end of these exposure times, the roots were qualitatively evaluated with scanning electron microscope to observe the presence of biofilm in external resorptions around the apical foramen. RESULTS: It was found that microorganisms were present in all exposure times, although structures suggesting the presence of biofilm with great conglomerate of bacteria showing structures similar to polysaccharide extensions were observed at the 10 th day of exposure. CONCLUSIONS: By means of this new methodology, it was possible to observe biofilm formation in the areas of external apical resorption after 10 days of exposure.

Spontaneous healing responses detected by cone-beam computed tomography of horizontal root fractures: a report of two cases.

Horizontal root fractures (HRF) usually affect the anterior teeth as a result of trauma, and generally heal spontaneously, depending on the vitality of the pulp. Diagnosis based on clinical findings, sensitivity tests, and radiographic examination is important to determine the presence of a root fracture and to prevent a root fracture from passing unnoticed. Cone-beam computed tomography (CBCT) has been used successfully for diagnosis and prognosis imaging of root fractures and has proved to be superior to other radiographic methods. This study reports two cases of dental trauma caused by a collision and a sports accident. The patients suffered horizontal root fractures in the maxillary left central incisor and in the mandibular left central incisor. The diagnosis of root fracture was confirmed by cone-beam computed tomography (CBCT) images, which also demonstrated spontaneous healing of the fracture line. The repair occurred by interposition of connective tissue in the former case and by interposition of bone and connective tissue in the latter case. The final diagnoses of both cases were based on CBCT images, indicating the importance of a CBCT examination to reach a firm diagnosis and to follow the healing process of root fracture cases, avoiding unnecessary radical endodontic treatment.

Orthodontic extrusion and implant site development: two case reports / Extrusão ortodôntica pré-implante: relato de dois casos clínicos

The aim of this study was to report two cases of orthodontic extrusion performed prior to dental implant placement. The first one reports the case of a 57 year-old-female who presented internal root resorption in the left central incisor, and orthodontic extrusion of this element was indicated. The treatment lasted 24 weeks. At the end of this period, the dental implant was placed. The second clinical event refers to a patient of 66 years of age who had vertical fracture in the left central incisor. In this case, the orthodontic extrusion was conducted in 12 weeks. At the end of this period, the dental implant was placed and also the temporary crown, but without occlusal contact. Both cases reported consisted of the involvement of the left central incisor in the aesthetic area and low bone density. The cases reported demonstrated that orthodontic extrusion is a viable alternative to the aesthetic and functional reconstruction with prosthesis over dental implants...

A extrusão ortodôntica é um procedimento clínico utilizado no decorrer dos anos com a finalidade, dentre outras, de preservação e ganho de tecido ósseo para permitir a restauração estética e funcional. Assim, este trabalho teve por objetivo relatar dois casos de extrusão ortodôntica realizada previamente à colocação do implante dentário. O primeiro deles relata o caso de uma paciente de 57 anos de idade que apresentou reabsorção interna no incisivo central esquerdo sendo indicada a sua extrusão ortodôntica. O tratamento durou 24 semanas. Ao final deste período foi colocado o implante no local. O segundo caso clínico refere-se a um paciente de 66 anos de idade que apresentou fratura vertical no incisivo central esquerdo. Optou-se por realizar extrusão ortodôntica, por um período de 12 semanas. Finalizado este período, foi realizada a colocação de implante e provisório sem contato oclusal. Observou-se nestes relatos que ambos os casos apresentados consistiram no comprometimento do incisivo central esquerdo, em área estética e de pouca densidade óssea. Esses dois casos demonstraram a extrusão ortodôntica como uma alternativa viável para a reconstrução estética e funcional com prótese sobre implante...

Influência do pré-alargamento na escolha da lima patência e lima apical inicial / Influence of preflaring in the choice of patency and initial apical files

O presente estudo avaliou a influência do pré-alargamento na escolha das limas patência e apical inicial. Quarenta canais mesiais de molares inferiores foram divididos em dois grupos. No primeiro, não foi realizado pré-alargamento e no segundo o mesmo foi realizado com brocas Gates Glidden. A mensuração do diâmetro anatômico do forame apical e do canal no comprimento de trabalho foi realizada com o auxílio de microscópio de forma retrógada. A escolha das limas patência e apical inicial foi determinada via canal. Quando o pré-alargamento não foi realizado, a diferença entre os diâmetros das limas e anatômicos foi maior. O pré-alargamento mostrou ser essencial na determinação da escolha das limas patência e apical inicial.

The present study evaluated the influence of cervical preflaring in the choice of patency and initial apical files. Forty mesial canals of mandibular molars were divided into two groups. In the first, no cervical preflaring was performed while in the second it was performed with Gates Glidden drills. The measurement of the anatomic diameter of the apical foramen and of the working length was performed by the retrograde method with the aid of a microscope. The choice of patency and initial apical files was determined in the root canal. When the preflaring was not performed, the difference between the diameters of the files and the anatomic diameters was greater. Preflaring was shown to be essential for the determination of patency and initial apical files.

Ação de medicações intracanal sobre biofilme microbiano localizado em áreas de reabsorção apical de dentes humanos extraídos / Action of intracanal dressing on bacterial biofilm located in apical resorption areas of extracted human teeth

O objetivo desse estudo foi avaliar a ação de medicações intracanal sobre biofilme microbiano localizado em áreas de reabsorção externa de dentes humanos extraídos. Para isto, 90 raízes de dentes humanos extraídos apresentando reabsorção apical externa foram submetidas à instrumentação padronizada. Em seguida foram divididas aleatoriamente em 6 grupos (n=15). As raízes foram expostas a cepa de E. faecalis (ATCC 29212) por 10 dias para induzir a formação de biofilme microbiano nas áreas de reabsorção externa apical. Após a formação do biofilme, foram inseridas medicações intracanal de acordo com os grupos. Grupo (HC): hidróxido de cálcio com solução fisiológica; Grupo (HC-CHX): hidróxido de cálcio com Clorexidina gel 2%; Grupo (HC-GEN) hidróxido de cálcio com extrato glicólico de gengibre 20%; Grupo (CHX): clorexidina gel 2%; Grupo (GEN): extrato glicólico de gengibre; Grupo controle (CC): solução salina fisiológica. Cada grupo permaneceu com medicação no interior dos canais radiculares por um período de 15 (quinze) dias. Ao final desse período as raízes foram avaliadas através do cálculo de unidades formadoras de colônias por superfície do espécime (UFC/ml) e através deanálise em Microscópio Eletrônico de Varredura (MEV). Os resultados foram analisados pelos testes estatísticos de ANOVA e Tukey. Verificou se que nenhuma medicação intracanal eliminou completamente o biofilme, mas houve redução dos microrganismos pela contagem de UFC/mL no grupo CHX, seguido pelo grupo HC. Os demais grupos apresentaram resultados semelhantes ao grupo controle. As imagens porMEV confirmaram a permanência do biofilme nas áreas de reabsorção apical. Conclui-se que as medicações intracanal não foram capazes de eliminar completamente o biofilme apical de E. faecalis in vitro

The aim of this study is to evaluate the effects of intracanal medication on microbial biofilm located in apical external root resorptions of extracted human teeth. 90 roots of extracted human teeth with apical external root surface were submitted to standardized instrumentation. The roots will berandomly divided into 6 groups of 15 roots each (n=15).The roots were exposed to E.faecalis strains (ATCC 29212) for 10 days to induce microbial biofilm formation in resorptions of apical external root surface. After biofilm formation, intracanal medications were inserted in each group. Group (HC): calcium hydroxide with sterile saline solution; Group (HC-CHX): calcium hydroxide with Chlorhexidine gel 2%; Group (HCGEN): calcium hydroxide with glycolic extract of ginger 20%; Group (CHX): chlorhexidine gel 2%; Group (GEN): extract of ginger 20%; Control group (CC): sterile saline solution. Each group remained with medication in the root canal for fifteen (15) days. After this period the roots were evaluatedby calculating the colony-forming units per surface of the specimen (CFU /ml) and by analysis of Scanning Electron Microscope. The results will beanalyzed using statistical tests of ANOVA and Tukey. It was found that nodressing completely eliminated biofilm, but it was a decrease in microorganisms number according to CFU / mL in the CHX group, followed by HC group. The other groups showed similar results to the control group. The SEM images confirmed the permanence of biofilm inareas of apical resorption. It is concluded that the dressing is not able to completely eliminate the biofilm apical E. faecalis in vitro

Variação anatômica de primeiro molar inferior e a importância de uma descontaminação efetiva

Introdução: a literatura tem relatado vários casos clínicos sobre variações anatômicas de molares mandibulares.Entretanto, poucos relatos mostraram tratamentos de primeiros molares inferiores permanentes com vistas à Endodontia atual. Objetivo: este trabalho tem o objetivo de relatar o tratamento endodôntico bem-sucedido de um primeiro molar mandibular que apresentava cinco canais radiculares diagnosticado com pulpite sintomática irreversível.Caso clínico: o acesso à câmara pulpar foi realizado,seguido da localização dos canais radiculares. Três canais na raiz mesial e dois na distal foram observados. Em seguida, o preparo químico mecânico foi realizado com limas manuais e rotatórias e irrigação copiosa com hipoclorito de sódio 2,5% durante toda a instrumentação. A obturação foi feita por meio da técnica híbrida de Tagger, e a restauração definitiva foi completada após uma semana. Conclusão: o conhecimento da anatomia do sistema de canais radiculares de primeiros molares mandibulares agrega informações à área,assim como contribuirá para o tratamento endodôntico com mais sucesso pelos profissionais.