Mandibular first molars are the first posterior teeth to erupt in permanent dentition and are those that most often suffer from caries. They are also the teeth that exhibit considerable anatomical variation and abnormalities regarding the number of roots and root canals. Therefore the clinician should know the various morphologic aberrations occurring in this tooth before starting the treatment. This case presents with mandibular first molars with 3 distal root canals and one root. The tooth was treated endodontically with the help of dental operating microscope.
CASE 1:
Local anaesthesia was induced using 1.8 ml of 2%
Lignocaine and Adrenaline (Xylocaine; AstraZeneca Pharma Ind Ltd, Bangalore,
India). The tooth was isolated using rubber dam and an endodontic access
opening was established. The orifices of mesiobuccal, mesiolingual, distobuccal
and distolingual were apparent and were initially located. The floor of the
pulp chamber was viewed under dental operating microscope (Carl Zeiss Meditec
AG, Germany), and with the help of this magnification and exploration of the
chamber floor with DG16 (Hu-Friedy, Chicago, IL), a third distal canal orifice
was located. The patency was confirmed with ISO #10 K-files. The orifices were
enlarged using Gates Glidden drills upto size 2 (figure 1B).
To confirm this unusual morphology, a Cone Beam Computed Tomographic imaging (CBCT) of the tooth was done with a tube voltage of 100 KV and a tube current of 8 mA. The cross‑sections of 0.5mm thickness were obtained in axial, transverse, and sagittal planes and were analyzed by CS 3D imaging software (Carestream Dental LLC) to find out the canal morphology. The CBCT scan slices revealed five canals, 2 in mesial root: mesiobuccal (MB), mesiolingual (ML), and 3 in distal root: distobuccal (DB), mid distal (MD) and distolingual (DL) (Figure 1C). Working lengths were determined using an apex locator (Root ZX; Morita, Tokyo, Japan) which was confirmed by intraoral periapical radiographs (Figure 1D).Cleaning and shaping was performed (Figure 1E) and obturation of canals were done (Figure 1F).Then, a composite core restoration was done. The patient was advised for a full coverage porcelain crown. The patient was asymptomatic at the three month follow-up (Figure 1G).
Access preparation was made in the right mandibular
first molar and two orifices were located mesially (buccal and lingual) and
three were located distally (buccal, middle and lingual) on observing under operating
microscope and manual exploration (figure 2B). Negotiation was done with 10K
file and working length was measured with electronic apex locator and confirmed
with periapical radiograph (figure 2C). The canals were prepared using hand K-files
till no. 20 followed by NeoEndo file (Orikam, India) till size 25, 0.06 taper in
mesial root canals and size 20, 0.04 taper in distal root canals (figure 2D).
During preparation, the canals were lubricated and irrigated with EDTA and 2.5%
NaOCl. Calcium hydroxide dressing was done in all the root canals and temporary
restoration was done for two weeks. Later the canals were coated with sealer and obturated in the lateral compaction technique and the tooth was
restored with composite resin (Figure 2E).
Review of case reports published from jan 2000-jan 2020
|
Author |
year |
No of roots |
No of distal roots |
No of canals |
No of distal canals |
|
Kottoor |
2010 |
2 |
1 |
5 |
3 |
|
Beyraghshamshir |
2019 |
2 |
1 |
5 |
3 |
|
Elhadi |
2018 |
2 |
1 |
5 |
3 |
|
Barletta |
2008 |
3 |
2 |
5 |
3 |
|
Y. Kimura |
2000 |
3 |
2 |
5 |
3 |
|
Seung-Jong Lee |
2006 |
4 |
3 |
5 |
3 |
|
Shweta Jain |
2011 |
2 |
1 |
5 |
3 |
|
Mariana Domingos |
2019 |
2 |
1 |
5 |
3 |
|
2 |
1 |
5 |
3 |
||
|
2 |
1 |
5 |
3 |
||
|
Kırıcı |
2019 |
2 |
1 |
5 |
3 |
|
Chandra |
2009 |
2 |
1 |
5 |
3 |
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