Single-Visit Endodontic Treatment and Digital Restorative Workflow for a Mandibular First Molar with Radix Entomolaris

Abstract

Diagnosing complex root canal anatomy in mandibular molars is often challenging, particularly in cases with radix entomolaris, which may be overlooked on conventional radiographs. Failure to recognize such variations can compromise treatment success. Cone-beam computed tomography (CBCT) enables accurate three-dimensional assessment, improving diagnostic confidence and clinical outcomes. Likewise, extensive coronal destruction following endodontic therapy requires a reliable restorative approach. Digital impressions obtained with intraoral scanners allow precise, efficient, and accurate fabrication of indirect restorations. A 17-year-old female patient presented with chief complaint spontaneous nocturnal pain in the mandibular left first molar. Clinical and pulp sensibility tests confirmed symptomatic irreversible pulpitis as a diagnosis. Radiograph examination showed radiolucency into the pulp without periapical lesion and the additional root in the middle between mesial and distal root. CBCT confirmed the presence of a radix entomolaris. Single-visit root canal treatment was performed with thorough chemomechanical preparation, irrigation activation, and single-cone technique obturation with a bioceramic sealer. The coronal structure was immediately reinforced with EverX Posterior composite to provide internal support. The definitive restoration was achieved through a fully digital workflow: an intraoral scanner was used for impression taking, and zirconia onlay was fabricated with CAD/CAM technology and luted with adhesive resin cement. This case highlights the importance of CBCT in diagnosing complex root canal anatomy and demonstrates how the integration of intraoral scanning with CAD/CAM-fabricated zirconia onlays can provide predictable functional and esthetic outcomes in endodontic treatment.