Cone beam computed topographic evaluation and endodontic management of a rare mandibular first molar with four distal canals.

Nidhi Sinha,Irfanul Huda,Bijay Singh,Ashwin Jain,Nitin Mirdha,Akshay Langaliya

doi:10.1155/2014/306943

Abstract

Root canal system is complex to understand because of its unpredictable nature. It differs for different teeth and for the same teeth in different individuals. Successful endodontic therapy thus depends on the clinician's ability to anticipate and look for these variations. A mandibular first molar with six root canals represents a rare anatomical variant, particularly when four canals are found in distal root. This case report discusses successful nonsurgical endodontic management of two-root mandibular first molar with four distal canals and two mesial canals reported for the first time in Indian population. Cone beam computed tomography was used as a diagnostic method to confirm the position and presence of 4 root canals in the distal root.

Highlights

Blayney in 1932 very aptly said that “probably the first requisite for successful operation is that the operator should be thoroughly familiar with the anatomy of the region” [1]
In case of mandibular first molars (MFM) 86% of missed canals are found in the distal root and 14% in the mesial roots [4]
Etiology of endodontic failure is multifactorial but majority of them can be attributed to the persistence of microorganisms and inability to access the full anatomy of root canal system

Summary

Introduction

Blayney in 1932 very aptly said that “probably the first requisite for successful operation is that the operator should be thoroughly familiar with the anatomy of the region” [1]. In case of MFM 86% of missed canals are found in the distal root and 14% in the mesial roots [4]. Complete disinfection of the entire coronoradicular space harbouring microorganisms and infected or necrotic pulp is essential for successful endodontic treatment. This necessitates clinicians to have a thorough working knowledge of radicular tooth anatomy along with a three-dimensional appreciation of internal anatomy of root canals with its possible variations [6]. Literature regarding four canals in distal root is absolutely scarce with only a few reported cases till date [11, 12].

Case Report

Discussion

Findings

Conclusion

Conflict of Interests