Symptomatic Irreversible Pulpitis – Mandibular Right First Molar with Three-Canal Anatomy

Overview — Mandibular right first molar presenting with symptomatic irreversible pulpitis. Patient Presentation A 40-year-old female patient presented with spontaneous, lingering pain localized to the mandibular right first molar (tooth #46). The pain was exacerbated by thermal stimuli and was not relieved by over-the-counter analgesics. Medical history was non-contributory. Diagnosis Clinical examination revealed a positive response to cold testing with prolonged, painful sensation, and mild tenderness to percussion. Radiographic evaluation confirmed periapical changes consistent with pulpal involvement. Based on clinical and radiographic findings, a diagnosis of symptomatic irreversible pulpitis with normal apical tissues was established. Pre-operative radiograph demonstrating the root canal anatomy of the mandibular right first molar. Canal Anatomy: Radiographic assessment revealed a three-canal configuration — Mesiobuccal (MB), Mesiolingual…