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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 30  |  Issue : 2  |  Page : 184-186

Endodontic management of six canals in mandibular first molar


Department of Conservative Dentistry and Endodontics, ITS Centre for Dental Studies and Research, Ghaziabad, Uttar Pradesh, India

Date of Web Publication5-Dec-2018

Correspondence Address:
Dr. Parul Mour Agarwal
Flat No. 1702, Tower 11, Orange County, Ahinsa Khand 1, Indirapuram, Ghaziabad - 201 010, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/endo.endo_99_17

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  Abstract 

Success in root canal treatment is achieved after meticulous mechanical and chemical cleansing of the pulp space succeeded by complete obturation of the root canal in its entire dimension. Pulp tissue remnants present in missed canals and spaces may compromise the treatment outcome. Therefore, it is important to diagnose the peculiar anatomy of such teeth during root canal treatment. This case report describes the diagnosis and successful endodontic management of an unusual mandibular first molar with three mesial and three distal canals.

Keywords: Mandibular first molar, missed canals, root canal treatment, six root canals


How to cite this article:
Agarwal PM, Taneja S. Endodontic management of six canals in mandibular first molar. Endodontology 2018;30:184-6

How to cite this URL:
Agarwal PM, Taneja S. Endodontic management of six canals in mandibular first molar. Endodontology [serial online] 2018 [cited 2018 Dec 12];30:184-6. Available from: http://www.endodontologyonweb.org/text.asp?2018/30/2/184/246945




  Introduction Top


Managing aberrant canals can be crucial, but the inability to find additional root canals may cause failures. Six root canals in mandibular first molars are unlikely, but the individual case should be evaluated carefully both clinically and radiographically to identify any anatomic anomalies. Probable aberration in the internal anatomy of human teeth should be known to assure favorable endodontic treatment.

Till date, the presence of more than two canals in the mesial root of mandibular molars has been illustrated in few clinical case reports. Amidst these, the percentage of middle mesial canal (MMC) in the lower mandibular molar is 1%–15%; also called “intermediary mesial canal” or “medial mesial canal.”[1],[2],[3],[4],[5] Kottoor et al.[6] and Ahmed et al.[7] found a prevalence rate of 4% and 3% for 3 canals in mesial and distal roots.

Intraoral periapical radiograph is necessary for the assessment of the canal number and morphology although it has its inherent limitation. However, precise inspection of root canal configuration can be done through discrete diagnostic methodologies such as magnifying loupes, dental microscope and auxiliary diagnostic aids like cone beam computed tomography can also be used.


  Case Report Top


A 35-year-old female patient reported to the Department of Conservative Dentistry and Endodontics with the chief complaint of pain in the posterior right mandibular region for the past 3 months. Her medical history was noncontributory. Clinical examination unveiled a carious mandibular right first molar (46). The preoperative radiograph of 46 [Figure 1] showed mesio-occlusal radiolucency involving the pulp with slight widening of the periodontal ligament space. The clinical diagnosis of chronic irreversible pulpitis was made, necessitating endodontic therapy.
Figure 1: Preoperative radiograph

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After local anesthetic was administered (lidocaine 2% with epinephrine 1:80,000) and rubber dam isolation, all carious tissue was excavated, and an adequate coronal access was made. Clinical inspection of the pulp chamber floor revealed orifices corresponding to the mesiobuccal, mesiolingual, and distal canals. However, on thorough observation with magnification (2.5x loupes, Carl Zeiss, Germany) and exploration using DG-16 explorer (Hu-Friedy, Chicago, IL, USA), the middle mesial and middle distal canal orifices were identified and subsequently negotiated [Figure 2], [Figure 3], [Figure 4]. Each root canal was prepared using Hyflex rotary instruments (Coltene, USA) in a crown-down technique. Irrigation was performed after instrumentation with each instrument using 5.25% sodium hypochlorite solution (Novo dental products Pvt., Ltd, India), ethylenediaminetetraacetic acid (Glyde, Maillefer, Dentsply, Switzerland) and subsequently flushed with sterile saline. The canals were dried using paper points and a calcium hydroxide dressing was given. At the next visit after 7 days, the tooth was asymptomatic and obturated using cold, laterally condensed gutta-percha (Dentsply, Maillefer) and AH-Plus sealer (Dentsply, Konstanz, Germany) [Figure 5], [Figure 6], [Figure 7], [Figure 8].
Figure 2: Working length radiograph

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Figure 3: Six separate orifices

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Figure 4: Magnified view of canals with intraoral camera

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Figure 5: Obturation done

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Figure 6: Six separate orifices postobturation

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Figure 7: Magnified view of canals postobturation with intraoral camera

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Figure 8: Postoperative radiograph

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  Discussion Top


The mandibular first molar is the earliest permanent tooth to erupt and is generally described as a group of teeth with two roots, mesial, and distal root. It is the most common tooth to undergo restoration and root canal treatment. The presence of two canals in the mesial root and one in the distal root of mandibular molars is 65% and the percentage of two canals in the distal root is 30%. The incidence of MMC has been reported to vary between 1% and 15% and that of middle distal canal in mandibular first molar to vary between 0.2% and 3%.[7],[8],[9] Although anatomical aberration in mandibular first molars is corroborated in the literature, variations in the anatomy of these teeth are not acknowledged by a great many dentists.

In the present case, the canals could be easily located by following the pulp chamber floor anatomy and application of basic concepts. Additional canals in mandibular molars are generally hidden by a dentinal projection which is lighter in color as compared to the pulp chamber floor. Loupes were used during the procedure as it increases the possibility of detecting additional canals.

Thus, judicious interpretation of angled radiographs, definite access cavity preparation and a thorough exploration of the pulp chamber under magnification, are fundamental prerequisites for a favorable treatment outcome.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Acknowledgments

The authors deny any conflicts of interest with respect to the authorship or publication of this article.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Martinez-Berna A, Badanelli P. Mandibular first molars with six root canals. J Endod 1985;11:348-52.  Back to cited text no. 1
    
2.
Weine FS. Case report: Three canals in the mesial root of a mandibular first molar. J Endod 1982;8:517-20.  Back to cited text no. 2
    
3.
Beatty RG, Krell K. Mandibular molars with five canals: Report of two cases. J Am Dent Assoc 1987;114:802-4.  Back to cited text no. 3
    
4.
Ricucci D. Three independent canals in the mesial root of a mandibular first molar. Endod Dent Traumatol 1997;13:47-9.  Back to cited text no. 4
    
5.
DeGrood ME, Cunningham CJ. Mandibular molar with 5 canals: Report of a case. J Endod 1997;23:60-2.  Back to cited text no. 5
    
6.
Kottoor J, Paul KK, Mathew J, George S, Mathew J, Roy A, et al. Apermanent mandibular second molar with seven root canal systems. Quintessence Int 2014;45:381-3.  Back to cited text no. 6
    
7.
Ahmed HA, Abu-bakr NH, Yahia NA, Ibrahim YE. Root and canal morphology of permanent mandibular molars in a Sudanese population. Int Endod J 2007;40:766-71.  Back to cited text no. 7
    
8.
Reuben J, Velmurugan N, Kandaswamy D. The evaluation of root canal morphology of the mandibular first molar in an Indian population using spiral computed tomography scan: An in vitro study. J Endod 2008;34:212-5.  Back to cited text no. 8
    
9.
Sert S, Bayirli GS. Evaluation of the root canal configurations of the mandibular and maxillary permanent teeth by gender in the Turkish population. J Endod 2004;30:391-8.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]



 

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