Three canals in the mesiobuccal root of a maxillary first molar: a case report

Endodontic management of the maxillary first molar with special root canals: A case report and review of the literature

BACKGROUND

As the complex anatomy of maxillary first molars is one of the major challenges in endodontic therapy, knowledge of the complicated root canal anatomy and configuration is crucial to ensure the success of endodontic treatment and prognosis. This article presents an endodontically managed left maxillary first molar with an unusual palatal root morphology. The available literature on the anatomic variation of maxillary first molars is also reviewed.

CASE SUMMARY

A 36-year-old man with no medical history presented to the Stomatology Department of Peking University Third Hospital complaining of a toothache during mastication in the maxillary left posterior region for approximately 3 mo. He had a spontaneous and intermittent toothache that had worsened, particularly at night. The diagnosis based on clinical examination, X-ray imaging, and cone beam computed tomography (CBCT) was symptomatic irreversible pulpitis. Nonsurgical endodontic therapy was performed for the left maxillary first molar. Five root canals revealed by CBCT included a special palatal root canal (1-2-1-shaped), two mesiobuccal root canals, and one distobuccal root canal. Evaluation of the CBCT images confirmed the root canal morphology and the clinician performed more effective cleaning, obturation, and therapy. Finally, the tooth was restored using composite resin, and the patient was satisfied with the result.

CONCLUSION

CBCT and a complete review of the literature may be beneficial for investigating the root canal system to achieve a biological and functional therapeutic effect.

The MB3 canal in maxillary molars: a micro-CT study

OBJECTIVES

To assess the internal and external morphologies of the mesiobuccal (MB) root of maxillary molars presenting a third root canal (MB3), using micro-computed tomography (micro-CT).

MATERIAL AND METHODS

Two-hundred and sixty-five extracted maxillary first and second molars with different root configurations were imaged in a micro-CT scanner at 19.6-μm pixel size. Sixteen teeth presenting MB3 canal were selected and evaluated regarding root configuration, minimal dentine thickness 2 mm under the furcation area, canal configuration of the MB root, MB3 canal morphology (location, independent or confluent orifice, and anatomy types), and the apical anatomy (aspect ratio, number of accessory canals and foramina, presence of isthmus, and independent MB3 foramen).

RESULTS

Overall, a high variability in canal configuration was detected in the MB root. MB3 canal was observed in 10 maxillary first molars and 6 maxillary second molars (n = 16). Minimal dentine thickness related to the MB3 canal at the coronal third was smaller than that of the MB1 canal. A complex internal anatomy comprising 13 different root canal configurations was observed. A high number of independent MB3 orifices at the pulp chamber floor was observed in the first molars (7 out of 10 teeth), while most of the specimens (n = 14) showed a confluent anatomy of the MB3 canal. A varied number of accessory canals and foramina were observed. At the apical third, isthmus could be observed in 6 specimens, while an independent MB3 foramen was present in 37.5% of the MB roots.

CONCLUSIONS

MB3 canal is a rare anatomical variation present in maxillary first and second molars. Its presence can be associated to a complex internal anatomy of the MB root which includes the presence of isthmuses and multiple accessory canals and foramina at the apical third, but also a thin dentine thickness at the coronal third and a confluent anatomy of the MB3 with the other main canals.

Evaluation of the root and canal systems of maxillary molars in Taiwanese patients: A cone beam computed tomography study

Background

This study evaluated variations in root canal configuration in the maxillary permanent molars of Taiwanese patients by analyzing patients' cone beam computed tomography (CBCT) images. Comparisons were made among these configurations and those previously reported. This information may serve as a basis for improving the success rate of endodontic treatment.

Methods

The root canal systems of 114 Taiwanese patients with bilateral maxillary first or second molars were examined using CBCT images. The number of roots, canals per root, and additional mesiobuccal (MB) canals, as well as the canal configuration were enumerated and recorded.

Results

Of the 196 maxillary first molars examined, three (1.5%) had a single root, two (1.0%) had two roots, and 191 (97.5%) had three separate roots. Out of all first molar roots examined, 44% of mesiobuccal (MB) roots had a single canal and the remainder had a second MB (MB2) canal. Of the 212 maxillary second molars examined, 16 (7.1%) had a single root, 51 (24.2%) had two roots, 143 (67.8%) had three roots, and two (0.9%) had four separate roots. For the MB roots, 92.3% of three-rooted maxillary second molars had a single canal and the remainder had an MB2 canal. In all three-rooted maxillary first and second molars, each of the distal and palatal roots had one canal.

Conclusions

The root canal configurations of the MB roots of maxillary molars were more varied than those of the distobuccal and palatal roots, and the root canal configurations of maxillary second molars were more varied than those of the first molars. These findings demonstrate CBCT as a useful clinical tool for endodontic diagnosis and treatment planning.

Abbott P. A Clinical Update on the Different Methods to Decrease the Occurrence of Missed Root Canals

One of the main causes of endodontic treatment failure is the clinician's inability to localize all the root canals. Due to the complex anatomy of the root canal system, missed canals are not uncommon. There are several strategies to decrease the possibility of missed root canals starting with good pre-operative radiographies. In order to overcome the limitations of conventional radiographies, cone-beam computed tomography (CBCT) can be considered. A correct access cavity preparation is of pivotal importance in localizing the orifices of the root canals. Furthermore, ultrasonics are very important devices to find missed canals. Increasing magnification and illumination enhance the possibility of finding all root canals during root canal treatment. The purpose of the present paper was to review all of the above techniques and devices.

Evaluation of the Root and Canal Morphology of Maxillary Permanent Molars and the Incidence of the Second Mesiobuccal Root Canal in Greek Population Using Cone-beam Computed Tomography

Objectives: Cone-Beam Computed Tomography is an alternative imaging technique which has been recently introduced in the field of Oral & Maxillofacial Radiology. It has rapidly gained great popularity among clinicians due to its ability to detect lesions and defects of the orofacial region and provide three-dimensional information about them. In the field of Endodontics, CBCT can be a useful tool to reveal tooth morphology irregularities, additional root canals and vertical root fractures. The objective of this study is to evaluate the root and root canal morphology of the maxillary permanent molars in Greek population using Cone-Beam Computed Tomography. Materials and Methods : 273 cone-beam computed tomography (CBCT) images were examined. The number of roots and root canals of the first and second maxillary molars were evaluated. Root canal configuration was classified according to Weine’s classification by two independent examiners and statistical analysis was performed. Results : A total of 812 molars (410 first and 402 second ones) were evaluated. The vast majority of both first and second molars had three roots (89.26% and 85.07%, respectively). Most first molars had four canals, while most second molars had three. In the mesiobuccal roots, one foramen was recorded in 80.91% of all teeth. Other rare morphologic variations were also found, such as fusion of a maxillary second molar with a supernumerary tooth. Conclusion : Within the limitations of this study, it can be concluded that more attention should be given to the detection of additional canals during root canal treatment in maxillary permanent molars. Towards this effort, CBCT can provide the clinician with supplemental information about the different root canal configurations for successful Root Canal Treatment.

Endodontic management of a maxillary first molar with three roots and seven root canals with the aid of cone-beam computed tomography

Variation in root canal morphology, especially in maxillary first molar presents a constant challenge for a clinician in their detection and management. This case report describes the successful root canal treatment of a three rooted right maxillary first molar presenting with three canals each in the mesiobuccal and distobuccal roots and one canal in the palatal root. The clinical detection of this morphologic aberration was made using a dental operating microscope, and the canal configuration was established after correlating and computing the clinical, radiographic and cone-beam computed tomography (CBCT) scan findings. CBCT images confirmed the configuration of the canals in the mesiobuccal and distobuccal roots to be Al-Qudah and Awawdeh type (3-2) and type (3-2-1), respectively, whereas the palatal root had a Vertucci type I canal pattern. This report reaffirms the importance of careful examination of the floor of the pulp chamber with a dental operating microscope and the use of multiangled preoperative radiographs along with advanced diagnostic aids such as CBCT in identification and successful management of aberrant canal morphologies.

Endodontic management of a maxillary molar with three mesiobuccal canals

It is imperative that the clinician should have comprehensive knowledge about the normal anatomy and its variations of the teeth as the deviations from the usual are very common. An increased awareness of unusual anatomy and a better understanding of the root canal system guide the clinician in accurate diagnosis and treatment of such variations in order to achieve a successful endodontic outcome. The maxillary first molar has been shown to have a wide variation in respect to the number of canals specifically noted in the mesiobuccal root. The current case report shows the successful management of a maxillary molar in which the mesiobuccal root had three canals.

Three root canals in the mesiobuccal root of maxillary molars: case reports and literature review

INTRODUCTION

The knowledge of root canal anatomy is essential to ensure a successful outcome of surgical and nonsurgical root canal treatment. The aims of this article were to present 2 cases of maxillary molars with 3 mesiobuccal root canals and to review the available literature on this anatomic variation.

METHODS

The first case described a nonsurgical root canal treatment of tooth #16 in a 29-year-old man with the aid of a dental operating microscope. In the second case, an extracted maxillary right first molar was scanned by a micro-computed tomographic system and reconstructed 3-dimensionally using modeling software.

RESULTS

In both cases, the mesiobuccal root had 3 canals (type 3-2 in case I and type 3-3 in case II), whereas the distobuccal and palatal roots had a single canal. The literature review showed that the overall incidence of 3-canaled mesiobuccal roots in maxillary molars ranged from 1.3%-2.4% and that the most common root canal configuration was type 3-2.

CONCLUSIONS

Clinicians should always anticipate the presence of extra canals in maxillary molars and use all the available tools to locate and treat these.

Midbuccal canals of maxillary molars evaluated by cone-beam computed tomography: endodontic management of two cases

Maxillary molars present variable root canal and root morphologies. This report describes the endodontic management of two cases of midbuccal canals found in maxillary molars. Midbuccal canals were present in a maxillary first molar with a single buccal root (Case 1), and in a maxillary second molar with three buccal roots (Case 2). An assessment of the internal configuration of these teeth was performed using cone-beam computed tomography (CBCT). Magnification with a dental operating microscope, surgical loupes, and the use of an endodontic explorer enabled the identification of the midbuccal canal orifices. The root canals in both cases were chemomechanically prepared and filled. Postobturation radiographic images revealed four (one midbuccal, two mesiobuccal and one palatal) and five (one midbuccal, two mesiobuccal, one distobuccal and one palatal) root canals, which were filled in Cases 1 and 2, respectively. Complex canal configurations of maxillary molars including the presence of midbuccal canals were presented. CBCT was a valuable tool in this diagnosis, as it provided a precise description of these unusual anatomical variations.

A rare root canal configuration of bilateral maxillary first molar with 7 root canals diagnosed using cone-beam computed tomographic scanning: a case report

INTRODUCTION

The complexity of the root canal system of maxillary molars presents a constant challenge in the diagnosis and treatment of these teeth. This case report describes the importance of a surgical operating microscope and cone-beam computed tomographic (CBCT) imaging.

METHODS

Root canal treatment of a left maxillary first molar with 3 roots and 7 canals was successfully performed. Seven canals were identified with the help of a surgical operating microscope and CBCT imaging. CBCT images also confirmed the 3 roots and 7 canals in the right maxillary first molar.

RESULTS

CBCT images confirmed a type IV canal pattern in the distal and palatal root, whereas the mesial root had a type VIII canal pattern.

CONCLUSIONS

The use of a surgical operating microscope and CBCT imaging helps the clinician to diagnose unusual anatomy of a tooth and facilitate successful endodontic treatment.

Extra roots and root canals in premolar and molar teeth: review of an endodontic challenge

The main goal of endodontic treatment is healing of the periapical tissues which are gained by elimination of bacteria and their byproducts from the canal and prevention from reinfection. Understanding of root canal anatomy is an essential part in endodontic treatment. Anatomic forms and variations in special teeth should be well known, one of them is extra roots/ canals. Although possible aberrations of canal anatomy should be considered for all teeth, some teeth should be highlighted. This review addresses the prevalence, diagnosis (clinical and radiographic), and endodontic management of teeth with extra roots/canals.

Dilemmas pertaining to three canals in the mesiobuccal root of a maxillary second molar: a case report

The mesiobuccal root of the maxillary molars is well known to pose a hindrance during endodontic therapy. Presented here is a case of a maxillary left second molar where three canals were located in its mesiobuccal root with the use of visual and diagnostic aids. Difficulties encountered during the process of unveiling the tooth's internal anatomy were discussed. The dilemmas encountered pertained to the root canal configuration, the nomenclature of the extra canals, and the justification for the presence of a third canal. The root canal configuration of 3-2-1 was confirmed for the mesiobuccal root using information gained from clinical, radiographic, and multi-detector computed tomography (MDCT) scan findings. This case demonstrates the need for efforts to locate extra canals in the mesiobuccal root of the maxillary molars as their internal anatomy remains a mystery.

Maxillary first molar with two palatal roots located under dental operating microscope

An awareness and understanding of the presence of an additional root and unusual root canal morphology is essential as it determines the successful outcome of endodontic treatment. A thorough knowledge of basic root canal anatomy and its variation is necessary for successful completion of endodontic treatment. This report points to the importance of looking for additional roots and canals with the help of operating microscope. Finding additional roots and canals would enable clinician to successfully treat a case that would otherwise not be successful.

Detection of Mesiobuccal Canal in Maxillary Molars and Distolingual Canal in Mandibular Molars by Dental CT: A Retrospective Study of 100 Cases

Objective. To detect presence of MB2 canal in maxillary molars and distolingual canal in mandibular molars by Dental CT. Material and Methods. A retrospective study of 100 Dental CTs was done. Axial and paraxial images obtained were used to assess the presence of MB2 canal in maxillary molars and distolingual canal in mandibular molars. Results. The youngest patient was of 11 years while the eldest patient was of 77 years. Males were 58 in number and females were 42 in number. MB2 canals were present in 57 patients and distolingual canal was present in 18 patients. Maximum MB2 canals were present in age group between 51 and 60 years, while distolingual canals were present in age group of 21–30 years. Conclusion. Dental CT allows adequate visualization of variation in root canal morphology and can be important diagnostic tool for successful endodontic therapy.

Maxillary first molar with seven root canals diagnosed with cone-beam computed tomography scanning: a case report

INTRODUCTION

The purpose of this article was to emphasize the importance of having a thorough knowledge about the root canal anatomy.

METHODS

This case report presents the endodontic management of a maxillary first molar with three roots and seven canals. The clinical detection of the seven canals was made using a surgical operating microscope and confirmed using cone-beam computed tomography (CBCT) scanning.

RESULTS

CBCT axial images showed that both the palatal and distobuccal root have a Vertucci type II canal pattern, whereas the mesiobuccal root showed a Sert and Bayirli type XV canal configuration.

CONCLUSION

This report describes and discusses the variation in canal morphology of maxillary first molar and the use of latest adjuncts in successfully diagnosing and negotiating them.

Maxillary molars with morphologic variations of the palatal root canals: a report of four cases

INTRODUCTION

The purpose of this article was to show the importance of the knowledge of the anatomy of root canals. Unusual root and root canal morphologies associated with both buccal roots of upper molars have been recorded in several studies in the literature. However, scientific information focusing on variations of the palatal root is rare.

METHODS

In this report, four cases are presented involving the root canal treatment of maxillary first and second molars with unusual morphologic configurations of the palatal root canals.

RESULTS

During root canal treatment, type IV and V configurations as defined by Vertucci of the palatal canals of two first and two second maxillary molars were identified. After mechanical instrumentation, the canals were obturated. Radiologic and clinical re-evaluation showed no signs of inflammation.

CONCLUSIONS

This report describes and discusses the possibility of different root and canal variations of the maxillary molars from a clinical point of view. Anatomic variations can occur in any tooth, and palatal roots of maxillary first and second molars are no exception. Therefore, careful examination of radiographs and internal anatomy of teeth is essential.

Analysis of the internal anatomy of maxillary first molars by using different methods

The success of endodontic treatment depends on the identification of all root canals so that they can be cleaned, shaped, and obturated. This study investigated internal morphology of maxillary first molars by 3 different methods: ex vivo, clinical, and cone beam computed tomography (CBCT) analysis. In all these different methods, the number of additional root canals and their locations, the number of foramina, and the frequency of canals that could or could not be negotiated were recorded. In the ex vivo study, 140 extracted maxillary first molars were evaluated. After canals were accessed and detected by using an operating microscope, the teeth with significant anatomic variances were cleared. In the clinical analysis, the records of 291 patients who had undergone endodontic treatment in a dental school during a 2-year period were used. In the CBCT analysis, 54 maxillary first molars were evaluated. The ex vivo assessment results showed a fourth canal frequency in 67.14% of the teeth, besides a tooth with 7 root canals (0.72%). Additional root canals were located in the mesiobuccal root in 92.85% of the teeth (17.35% could not be negotiated), and when they were present, 65.30% exhibited 1 foramen. Clinical assessment showed that 53.26%, 0.35%, and 0.35% of the teeth exhibited 4, 5, and 6 root canals, respectively. Additional root canals were located in this assessment in mesiobuccal root in 95.63% (27.50% could not be negotiated), and when they were present, 59.38% exhibited 1 foramen. CBCT results showed 2, 4, and 5 root canals in 1.85%, 37.05%, and 1.85% of the teeth, respectively. When present, additional canals showed 1 foramen in 90.90% of the teeth studied. This study demonstrated that operating microscope and CBCT have been important for locating and identifying root canals, and CBCT can be used as a good method for initial identification of maxillary first molar internal morphology.

The Effect of Operator Experience in Locating Additional Canals in Maxillary Molars

The purpose of this study was to determine the influence of operator experience on the ability to locate and fill extra canals in maxillary first and second molars in vivo. The number of canals located and filled from maxillary first and second molars was recorded from three endodontic residents during the first 6 months of their training, and then compared to the last 6 months of their training in a 2-yr endodontic residency program. Data from each resident was collected and compiled together. The study showed a statistically greater percentage of additional canals located and filled by residents in their last 6 months, as compared to the same residents in their first 6 months in maxillary first and second molars (p < 0.05). Therefore, operator experience was found to improve the ability to locate and fill additional canals in maxillary first and second molars.