Endodontic management of a maxillary second molar with five root canals: a case report

Abstract

T he success of endodontic treatment depends on filling the root canal system after careful cleaning. To minimize the risk of failure arising from insufficient cleaning and filling of the root canal, a complete picture of the anatomy of the root canal system of the tooth to be treated is needed. [1] In terms of anatomy, maxillary second molars are generally similar to maxillary first molars. A distinguishing characteristic of maxillary second molars is convergence of three roots, with complete unification of these roots in some cases. In addition, maxillary second molars have shorter and curved roots than maxillary first molars. Maxillary second molars generally have just a single canal in each root. [2] Compared with maxillary first molars, they are less likely to have a secondary canal in the mesiobuccal root. According to previous studies, the incidence of a second mesiobuccal canal in maxillary second molars is 24.3%, [3] whereas that of maxillary second molars with four roots is 0.4%. [4] Another study reported an incidence of the aforementioned variation of approximately 1.4%. [5] Although it is easy to clinically detect these two palatal canals that have significantly low incidences, they may be undetected during root canal treatment because of superposition that occurs on radiography. Thus, it is important to check for the presence of extra palatal roots and canals during root canal treatment of maxillary second molars. In this case report, we describe endodontic treatment of a maxillary second molar with five canals, two of which were palatal.A maxillary second molar tooth with two palatal roots is an uncommon anomaly. In this case report, we describe non-surgical endodontic treatment of a maxillary second molar with two palatal roots. The second palatal root was discovered during preparation of the endodontic access cavity. Biomechanical preparation of all root canals was performed using nickel-titanium (NiTi) rotary instruments. Root canal obturation was performed with a root canal sealer and gutta-percha cones using the lateral compaction technique. The tooth was then restored with composite resin. It may be difficult to detect extra roots in the maxillary posterior region on radiographs because of superposition of various anatomic structures. A careful examination of the pulp chamber can aid in detecting extra canals that are not radiographically visible.

Variations in The Number of Roots and Root Canals in Maxillary Second Molars- A Review of Literature

“…Searching for a missing canal can result in iatrogenic mishaps, such as perforation or premature removal of the tooth(Table 2). This type of error can be avoided if a clinician has a general idea of the variations in the root canal system (Uslu, 2018). It can be achieved by detailed preoperative assessment of the root canal system with several angled root canals and the use of CBCT while providing contradictory opinions regarding the complex root canal system.…”