Endodontic management of a mandibular first molar with six root canal systems

Abstract

Internal anatomy of pulp is complex. The first mandibular molars typically have two roots, one mesial with two root canals and another distal root, which contains one or two canals. A 20-year-old female patient reported with intermittent pain and incomplete root canal treatment in left lower back region since 1-week. Refined access cavity revealed initially two canals in mesial and two canals in the distal root. With operating microscope and cone beam computerized tomography, two additional canals (L-mesio-buccal and B-mesio-lingual) were identified in mesial root. One-year follow-up showed patient was asymptomatic and complete healing of periapical radiolucency.

Maxillary first molar with 7 root canals diagnosed using cone-beam computed tomography

“…In these cases, careful examination of preoperative image exams can be helpful. 3 7 8 9 Periapical radiographs taken in different angulations are an essential part of endodontic treatment for the identification of root and canal configuration. However, the amount of information gained from periapical radiographs is limited by the fact that radiographs are compressed 2 dimensional image of a 3 dimensional object, and this may be the reason the radiographic evaluation of the tooth did not indicate any aberration in the canal anatomy.…”

“…Several studies showed the quality of CBCT imaging and its clinical application for studying root canal morphology before clinical endodontic treatment. 3 7 8 9 Yet, the use of CBCT imaging should be indicated only in cases in which complex anatomy and/or morphology is suspected. Although minimal, CBCT imaging still uses ionizing radiation.…”

“…A comprehensive understanding of the complexity of root canal systems is imperative for successful root canal treatment. 1 2 3 Recognition of anatomic variations is a real challenge for clinicians before undertaking therapy, regardless of the teeth that are to be treated. Maxillary first molars have been frequently investigated because of their complex root anatomy and canal morphology.…”

Endodontic management of contralateral mandibular first molars with six root canals

“…[ 15 ] Goel et al reported that 60% of the mesial root of permanent mandibular first molars presented two foramina (Vertucci Type IV), whereas 6.7 and 3.3% of these molars had three (Vertucci Type VIII) and four foramina (Sert and Bayirli Type XX), respectively. [ 16 ] Few researchers[ 6 7 17 ] reported the presence of six canals in mandibular first molars, but none of these reported contralateral molars with diverse morphologies.…”

“…[ 5 ] Earlier few authors have reported mandibular first molars with additional canals. [ 6 7 8 ] This case report describes endodontic management of bilateral mandibular first molar with radix and diverse canal configurations in their mesial roots.…”