First appointment procedure: Access opening, copious NaOCl 2,5% irrigation, two canal entries located by pre bending and scouting through deep main canal constriction, followed by 06,08,10,15 K files from Many. Irrigation protocol: NaOCl 2,5%, absorbent paper points + EDTA 17%, absorbent paper points, CHX 2% for 1-2mn, absorbent paper points, intracanal medication: Ca(OH)2 loaded with Barium Sulfate + Iodine (Metapaste), Teflon, Cavit. Barium sulfate displays a third canal in post operative dental X Ray film.
Patient is seen 3 weeks later, no more symptoms, scouting with pre bent 08 K file could not be of any use in locating this third canal entry neither as high magnification with coaxial Xenon light. Two previously located canals are shaped up to a 20 K file, followed by ProTaper “original” NiTi file sequence up to F3 in order to allow for ultrasonication. Adding ultrasonication to same irrigation+drying protocol, Pulp Canal Sealer and cold lateral followed by warm vertical in order to maximize the odds of “sealing” what will remain, despite all my efforts, an accessory canal.