Follow-up of Non-Surgical Endodontic Treatment of Permanent Mandibular First Molars with Middle Mesial Root Canals –Four Clinical Case Series Report with a Mini Literature Review

Abstract

Introduction: Root canal treatment’s long-term favorable prognosis is dependent on a good pulpal-periapical diagnosis and periodontium health, clear preoperative radiographs, an adequate understanding of complex root canal anatomy and endodontic pathology, proper treatment protocol that involves careful examination of root anatomy, identifying unusual root canal anatomy, access modification, negotiation of all the canals, complete debridement by shaping and chemical disinfection of all the portals of entry and exit within the root canal system, hermetic three- dimensional obturation of root canal space with an inert filling material followed by a fluid-tight tooth coronal seal. Clinicians are challenged with aberrations in the root canal anatomy of permanent mandibular molars especially when this anatomy is difficult to visualize from radiographs. The presence of a middle mesial root canal in permanent mandibular molars has been reported. Extensive exploration of the groove between mesiobuccal and mesiolingual orifices in mandibular permanent molars may reveal the presence of additional middle mesial canal orifice. Objectives: This clinical case series discusses the Follow-up of non-surgical endodontic management of four mandibular permanent first molars with an additional Middle Mesial (MM) canal in the mesial root. A mini literature review of this anatomical anomaly is also presented. Materials and Methods: The four mandibular molars with middle mesial canal endodontic cases done at Endodontics Clinic, Primary Health Care Corporation (PHCC), Qatar by the author in the year 2021 were reviewed with follow-up in the year 2023, address the endodontic management from identification of additional canals to complete obturation and follow up. Results: Clinical follow-up post endodontic treatment demonstrated that the treated molars with extra canals were asymptomatic with no sensitivity to percussion or palpation, no swelling or tooth mobility, and normal periodontal ....