Four canals in the mesial root of a mandibular first molar. A case report under the operating microscope

Department of Endodontics, Dental School, University of Athens, Anthron 2, Patisia, 11143 Athens, Greece.
Australian Endodontic Journal (Impact Factor: 0.74). 09/2007; 33(2):84-8. DOI: 10.1111/j.1747-4477.2007.00068.x
Source: PubMed

ABSTRACT In this era of microscope-assisted endodontics, finding variations in root canal system anatomy is not uncommon. Operating microscopes combined with careful clinical examination and radiographic interpretation can aid the clinician to successfully treat cases with such internal anatomy. The understanding of this view enables the possible location of additional canals in any tooth requiring endodontic treatment. The present clinical article demonstrates a rare anatomical complexity in the mesial root of a mandibular first molar. Four independent root canal orifices were found in this root by clinical detection with the aid of a dental operating microscope. This case shows that additional canals can be located in any root undergoing endodontic treatment and clinicians should always be aware of aberrant internal anatomy.

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    • "Root canal configuration with two distal canals varies from 20% to 46% in different populations [3] [4]. The identification of three [5] [6] or four [7] canals in the mesial root or three canals in the distal root [8] is still anatomical variations reported in the literature. "
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    ABSTRACT: Endodontic treatment of mandibular molars is challenging because of variable root canal morphology. The nonsurgical endodontic management of a mandibular first molar presenting an independent middle mesial canal is reported. After coronal access, additional clinical inspection of the mesial canals' orifices and their interconnecting groove using an endodontic explorer and 4.5× loupes enabled the identification of the middle mesial canal orifice. All root canals were chemomechanically prepared and filled. The tooth was asymptomatic and functional after 4 years of followup. Cone beam computed tomography (CBCT) images revealed normal periapical status and three-dimensional (3D) anatomical aspects of the root canal system.
    04/2013; 2013:891849. DOI:10.1155/2013/891849
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    • "Root canal nomenclature Reference M, DB, MD, DL MB, ML, DB, MD, DL, [5] M, D MB, ML, MD, DB, DL [15] M, DB, DL MB, ML, DB, DL, MD or third distal [12] M, D MB, MM, ML, D [16] M, D MB, MM, ML, DB, DL [13] M, D M, D [11] Radix entomolaris [17] Radix paramolaris [18] MB, ML, D MB 1 , MB 2 , ML 1 , ML 2 , DB, D, DL [7] MB, ML, DB, DL ML, MB, DL, MD, DB1, DB2 [10] M, DB, DL 2 mesial, 3 distal [19] M, D 4 mesial canals, 1 distal canal [20] Mesiocentral canal [21] M, D MB, ML, 3rd mesial, DB, DL [22] M, DB, DL MB, ML, 2DB, 1DL [9] "
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    ABSTRACT: Several terminologies have been employed in the dental literature to describe the roots and root canal systems of mandibular molars with no consensus being arrived at, thus far. The anatomical relation of roots and their root canals were identified and a naming system was formulated. The proposed nomenclature attempts to make certain essential modifications to the traditional approach to accommodate the naming of various aberrations presented in mandibular molars. A simple, yet extensive nomenclature system has been proposed that appropriately names the internal and external morphology of mandibular molars.
    International Journal of Dentistry 02/2012; 2012:814789. DOI:10.1155/2012/814789
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    • "Ghoddusi et al/2007 In vivo (PA radiographs) 1 4 roots, 6 canals, 6 foramina. 1 canal on each M root and on DL, 3 canals on D. Kontakiotis and Tzanetakis/2007 In vivo (PA radiographs) 1 5 canals. 4 on M that merge in 1 foramen, 1 canal on D. Ashwin and Arathi/2006 In vivo (PA radiographs) 2 Taurodontism on both mandibular first molars of the patient. "
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    ABSTRACT: The main goal of endodontic therapy is to prevent or heal apical periodontitis. However, root canal anatomy might present a clinical challenge directly related to the treatment outcome. The purpose of this study was to review published literature related to root anatomy and root canal configuration of the permanent mandibular first molar. An exhaustive search was undertaken to identify published literature related to the root anatomy and root canal morphology of the permanent mandibular first molar by using key words. The search of the MEDLINE database included all publications from 1966-May 2010. Selected articles were then obtained and reviewed. Data evaluated and summarized in the data sheet included methodology, population, number of teeth per study (power), number of root canals, type of root canal configuration, and identification of number of apical foramina. Forty-one studies were identified including a total of 18,781 teeth. The incidence of a third root was 13% and was strongly correlated with the ethnicity of the studied population. Three canals were present in 61.3%, 4 canals in 35.7%, and 5 canals in approximately 1%. Root canal configuration of the mesial root revealed 2 canals in 94.4% and 3 canals in 2.3%. The most common canal system configuration was Vertucci type IV (52.3%), followed by type II (35%). Root canal configuration of the distal root revealed type I configuration in 62.7%, followed by types II (14.5%) and IV (12.4%). The presence of isthmus communications averaged 54.8% on the mesial and 20.2% on the distal root. The number of roots on the mandibular first molar is directly related to ethnicity. Root canal morphology and configuration might present the clinician with a complex anatomy requiring more diagnostic approaches, access modifications, and clinical skills to successfully localize, negotiate, disinfect, and seal the root canal system.
    Journal of endodontics 12/2010; 36(12):1919-31. DOI:10.1016/j.joen.2010.08.055 · 2.79 Impact Factor
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