A ten-year old girl was referred to stomatological hospital of Jiangsu province with a history of toothache in the right maxillary region in March 16th, 2014. The patient’s medical history was non-contributory. Clinical examination revealed an extensive distal obturation with secondary carious lesion in the right maxillary first molar and tenderness to percussion, with negative response to cold testing. The preoperative radiographic views revealed four roots with open apical foramen. The tooth was diagnosed with symptomatic apical peridontitis.
The patient was prepared for apexification. The access cavity of the maxillary first molar is usually triangular in shape. In the current case, the pulp chamber of this tooth was broader in the palatal areathe access cavity was prepared in trapezoidal shape. Apexification was performed and the root canals were cleaned and shaped under the copious irrigation with 3% H2O2 solution and normal saline. In the intraoperative radiographic views, the gutta-percha was put in the root to reveal the length of the roots.