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: 0.59). 09/2007; 33(2):84-8. DOI: 10.1111/j.1747-4477.2007.00068.x
Source: PubMed


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.
    Full-text · Article · Apr 2013
    • "Most of the reported cases of third mesial canal have been in patients of 40 years of age or more. Though the presence of a third mesial canal has been reported by many authors, presence of fourth mesial canal has been reported only thrice.[789] Goel et al., in an in vitro study on Indian population reported an incidence of 3.3% of four canals in the mesial root of mandibular first molar.[18] "
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    ABSTRACT: Successful root canal treatment depends on adequate cleaning, shaping, and filling of the root canal system. The presence of middle mesial (MM) root canal of mandibular molars has been reported by various authors. But incidence of four canals in mesial root of mandibular molar is very rare. The aim of this case report is to present and describe the identification and management of a mandibular first molar with four canals in the mesial root and single canal in the distal root.
    No preview · Article · Apr 2013 · Journal of Conservative Dentistry
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    • "In addition, cases with three canals in the distal root and two in the mesial root,[5859] two canals in the mesial root and three canals in three distal roots,[93] two canals in the disto-lingual root,[67] two roots and one canal in each,[94] Four canals in mesial root of mandibular molar,[95] molar with seven canals: 2 mesiobuccal, 2 mesiolingual and 3 distal canals[96] were reported. "
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    ABSTRACT: The success of root canal therapy depends on the locations of all the canals, thourough debridement and proper sealing. At times the clinicians are challenged with variations in morphology of root canal. This review article attempts to list out all the variations of permanent mandibular first molar published so for in the literature. An exhaustive search was undertaken using PUBMED database to identify published literature from 1900 to 2010 relating to the root canal morphology of permanent first molar by using key words. The selected artcles were obtained and reviewed. Total ninty seven articles were selected out of which 50 were original article and forty seven were case reports. The incidence of third canal in mesial root was 0.95% to 15%. The incidence of three rooted mandibular first molar was 3% to 33%. Only ninety cases reported with c-shape canal configuration. Incidence of Taurodintism without congenital disorder was very rare. The root canal treatment requires proper knowlegde of variations in root canal morphology in order to recognise, disinfect and seal all portal of exit. This can be accomplished with proper diagnosis using newer modes, modification in access preparation, use of operating microscope, enhanced methods of disinfecting and sealing of all canals.
    Full-text · Article · Mar 2013 · Journal of Conservative Dentistry
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