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RO0111

I 19 case report _ challenging RCTs I roots1_2011 Fig. 2), and an orifice barrier was made using Gradia Flow (GC). After root-canal obturation, three radio- graphs were taken, one with normal angulation and twoangled(Figs.3a–c).Theradiographsclearlyreveal the complexity of the root-canal system and the 3-D obturation. Post-endodontic composite obturation was done with Miris 2 (Coltène/Whaledent). _Case II: Three-rooted mandibular first molar A 22-year-old male patient was referred to the clinic with pain in teeth #29 and 30. He was in good health, with mild to acute pain to percussion. The referring dentist was concerned about the complex anatomy,whichwasthereasonforthereferral.After taking a preoperative radiograph (Fig. 4), an access cavity through the crown was made using a Crown Cutterburandasafe-enddiamondbur(KOMET/Gebr. Brasseler). Cavity refinement was done with the Start-X ultrasonic tip #1 and a #3 Mueller bur (Mani, Inc.; Fig. 5). Coronal pre-enlargement was necessary because of the calcified orifices of the root canals. This was done with a ProTaper SX file with brushing move- ments. Negotiation of the canals was done with a 10.02 K-Flexofile (DENTSPLY Maillefer) with the aid of Glyde Gel (DENTSPLY Maillefer). A glide path was established with PathFiles and shaping was done us- ing the ProTaper System (DENTSPLY Maillefer). After apical gauging, the four canals were shaped to a ProTaperF3filewith5%sodiumhypochloriteirriga- tion. Final irrigation was done using ultrasonically activated 5% sodium hypochlorite and 40% citric acid. A final rinse was done with 95% ethanol. Obtu- ration of the root-canal system was performed with the Alpha II and Beta devices using the Continuous WaveofCondensationtechnique,andflowablecom- posite was used to create the orifice barriers (Gradia Flow; Fig. 6). The post-endodontic build-up was made using a fibre post and composite (Core-X Flow and Ceram-X Duo, DENTSPLY DeTrey), and a final radiograph was taken (Fig. 7). _Conclusion When dealing with such challenging cases, one needs to have an immense amount of patience and a great deal of curiosity to discover the hidden secrets of the root-canal system. After unveiling all of the pulp chamber anatomy, one can continue moving towards the apical foramen to reach the endodontic goal:toclean,shapeandfillthe3-Droot-canalspace the best way one can._ Editorial note: A complete list of references is available fromthepublisher. Dr Bojidar Kafelov graduated from the Medical University of Sofia Dental School in 2009.He has completed many continuing education courses in the field of endodontics.He has been a practising endodontist at the Svedent dental clinic full time since 2009 and is a member of the Bulgarian Endodontic Society and the Bulgarian Society ofAesthetic Dentistry.Dr Kafelov can be contacted at b.kafelov@gmail.com or via the dental clinic’s website,www.svedent.com. _about the author roots Fig. 4 Fig. 5 Fig. 6 Fig. 7 Fig. 3a Fig. 3b Fig. 3c