Endodontic Retreatment of Maxillary Second Molar with Four Roots

Abstract

The present communication describes the endodontic retreatment of a rare four-rooted maxillary second molar. A 25-year-old patient was referred to our dental practice requesting an apicoectomy because of continuous and permanent pain reaction six months after the first endodontic treatment. The sent radiograph demonstrated three filled root canals (one mesial, two distal) and four radiographically superimposing roots (two mesial, two distal). Due to the diagnosed chronic apical periodontitis and based on the visible untreated root canal, we decided to endodontically re-treat the quadrangular tooth against the referred apicoectomy. In the first session, only the previously untreated mesiopalatal root canal was mechanically prepared and filled with a corticosteroid- and tetracycline-containing paste. After two symptom-free weeks, the gutta-percha was removed from the other canals and calcium hydroxide was applied. Another two weeks later, the four root canals, whose orifices were “irregular quadrilateral” shaped on the pulp chamber floor representing Versiani Type A, were obturated. After the verification of this rare anatomy by cone beam computed tomography, the tooth was classified as Christie’s radicular type II. One characteristic of this type is parallel running buccal and palatal roots, which caused a radiographic superimposition and probably led to the endodontic mistreatment in the first case.

Endodontic Treatment of a Maxillary First Molar With Two Separate Palatal Roots: A Case Report

“…A thorough review of pre-operative X-rays is essential to identifying and locating additional roots [2]. Preoperative X-ray imaging that clearly shows the periodontal ligament of the two palatal roots and their respective independent root canal images is the gold standard for diagnosis [12][13][14]. A blurred or unclear image of the palatal root or its canal contour could indicate the existence of a second palatal root.…”

“…A blurred or unclear image of the palatal root or its canal contour could indicate the existence of a second palatal root. In such cases, taking additional mesial or distal offset radiographs is advisable, particularly for Type II configurations, where the buccal roots might overlap with the palatal root [12][13][14]. Utilization of special diagnostic methods, techniques, and equipment is sometimes necessary.…”

“…The anatomical intricacies of maxillary molars pose significant challenges in endodontic treatment, often necessitating sophisticated diagnostic and therapeutic strategies [8][9][10]. While most maxillary molars typically have three roots -two buccal and one palatal -there have been rare instances of maxillary molars with double palatal roots, with a reported global incidence of 0.047% [10][11][12][13][14]. This anatomical variability underscores the need for clinicians to understand these structural characteristics in-depth for effective endodontic treatment [10].…”

Four-Rooted Maxillary First Molars: A Systematic Review and Meta-Analysis

“…In the present review, only 15.1% of the case reports [ 11 , 69 , 82 , 87 , 96 , 100 , 102 , 108 ] documented further anatomical variations combined with the exhibition of four roots ( Table 2 ). However, dental professionals should be aware of this rare anomaly to avoid treatment errors that result oftentimes in endodontic retreatments [ 93 , 95 , 98 , 101 , 115 ].…”