Retreatment Case with Radix Paramolaris

Name: Dr. Nuno Miguel Belo Gonçalves 

Location: Portugal

Tooth: #36 FDI (#19 US)

Instruments Used: ProTaper Next; H, C+, and K hand files


The Case


A 19-year-old female came to the clinic with pain in her lower left jaw. A radiotransparent lesion was found in #36 FDI (#19 US), as well as a previous endodontic treatment.


The apical diagnosis was symptomatic apical periodontitis.


In the first observation of the x-ray, I noticed the distal canal seemed to have some calcification, and I noticed an extra mesial root, also known as radix paramolaris.




There was no major problem in accessing the canals, other than dealing with the old restoration.


Post-access, I found 4 canals rather than the previously thought 3.


I found some resistance in the distals, but I was able to achieve patency with the help of C+ files and lubricant. I then used ProGlider files to achieve a glide path in every canal.


Because I achieved the glide path, I felt at ease during the rest of the instrumentation phase. I used ProTaper Next files, which have a great performance in terms of flexibility and performance while cutting dentin. I used Protaper Next X3 on the distal and mesial roots.


My irrigation protocol is warm NaOCl 5.25% before, during, and after instrumentation. For the final irrigation, I use Citric Acid 20%, and then I use NaOCl 5.25% again.


AH Plus sealer is my sealer of choice. This case was no different.


I obturated using the cold lateral condensation technique. As you can see in the final x-ray, I was able to achieve the obturation of a lateral canal in the mesial root.


The patient was sent back to the referring dentist. I advised an overlay/crown for rehabilitation on the tooth.





Dr. Nuno Goncalves

Dr. Nuno Miguel Belo Gonçalves was born in Lisbon, Portugal, in 1992. He finished his Master's Degree in Dental Medicine at Instituto Superior de Ciências da Saúde Egas Moniz in 2015, where he was invited to be an endodontic mentor and teach pre-graduate students. He began practicing General Dentistry and has since focused in endodontics. Dr. Nuno Gonçalves is also a member of the Portuguese Endodontic Society.

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