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 Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 2  |  Issue : 1  |  Page : 37-39

Five canalled and three rooted mandibular first molar: A rarity


1 Department of Public Health Dentistry, Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh, India
2 Department of Periodontology, Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh, India
3 Department of Orthodontics and Dentofacial Orthopaedics, Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh, India

Date of Web Publication17-Apr-2013

Correspondence Address:
Vinay Kumar Bhardwaj
Department of Public Health Dentistry, Himachal Pradesh Government Dental College and Hospital, Shimla, Himachal Pradesh 171 001
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-344X.110559

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  Abstract 

Success of endodontic treatment depends on the proper identification of all the canals, thorough chemo-mechanical preparation followed by three dimensional obturation with hermetic seal. Failure of any of these steps may occur due to unusual tooth morphology. Usually mandibular molars have two roots with three canals (mesiobucccal, mesiolingual and distal) but in few teeth, the number of roots and canals vary. The variation in the number of roots is called radix entomolaris. This article presents a case report of mandibular first molar with extra distal root and five root canals. This report highlights the importance of radiographic examination and points out the need to look for additional canals and unusual canal morphology associated with a mandibular first molar.

Keywords: Five canals, mandibular molar, three roots, two distal roots


How to cite this article:
Bhardwaj VK, Jhingta P, Negi N, Sharma D, Vaid S, Fotedar S, Abbot SK. Five canalled and three rooted mandibular first molar: A rarity. Int J Health Allied Sci 2013;2:37-9

How to cite this URL:
Bhardwaj VK, Jhingta P, Negi N, Sharma D, Vaid S, Fotedar S, Abbot SK. Five canalled and three rooted mandibular first molar: A rarity. Int J Health Allied Sci [serial online] 2013 [cited 2019 Sep 20];2:37-9. Available from: http://www.ijhas.in/text.asp?2013/2/1/37/110559


  Introduction Top


The study of root anatomy of teeth has an endodontic as well as an anthropological significance. Mandibular first permanent molars usually have two roots, placed mesially and distally and three root canals. A variation in number of roots as well as canal morphology is not uncommon. The third root usually appears as a thin strand in the disto-lingual position. Three-rooted mandibular first molars occur in less than 5% of white persons, Africans, Eurasians and Indians. [1],[2]

The main objective of root canal treatment is the thorough mechanical and chemical cleansing of the entire pulp space followed by complete obturation with an inert filling material. [3] Therefore, it is imperative that aberrant anatomy is identified prior to and during root canal treatment of such teeth. Unusual canal anatomy associated with the mandibular first molar has been reported in several Studies. In 1974, Vertucci and Williams [4] as well as Barker et al. [5] described the presence of an independent middle mesial canal. Since then, there have been multiple case reports of aberrant canals in the mesial root of the mandibular molar. [6],[7] In a radiographic study of extracted teeth Goel et al. [8] reported mandibular first molars had three distal canals in 1.7% of specimens. The third root is radiographically evident in about 90% of cases, [9] but may be difficult to see because of its slender dimensions. [10] The present report describes root canal treatment in a mandibular first molar containing three roots and five canals.


  Case Report Top


A 21-year-old male patient attended comprehensive oral health-care clinic of the department of Public-health dentistry, presented with a non-contributory medical history, a chief complaint of gingival soreness in his right mandibular region. Pain was continuous and aggravated on biting at tooth no. 46. Clinical examination revealed tenderness on vertical percussion and no response to thermal sensitivity tests in the tooth. Radiographic examination revealed deep caries with pulpal involvement. On keen observation, distinct supplemental distal root was identified on the radiograph [Figure 1]. Root canal treatment was indicated. Access preparation was done with an endo access bur no. 1 (Dentsply Switzerland). The coronal necrotic pulp tissue was removed and the chamber irrigated with 5% sodium hypochlorite solution. Five root canal orifices were detected (two mesial and three distal). The root canals were located with DG-16 endodontic explorer and patency of canals was made with 15 number K-file (Mani, Japan). Working length was determined radiographically. Diagnostic radiograph was taken which revealed five distinct canals opening at an identical apex [Figure 2]. During instrumentation all the five canals presented separately. At the third visit, all canals were dried and filled by cold lateral condensation of gutta-percha with a calcium hydroxide-based sealer. Access cavity was restored with Zinc oxide eugenol cement and a post-obturation radiograph was taken, which has shown distinct well obturated five canals [Figure 3]. The patient experienced no post-operative sequelae and was referred for appropriate coronal restoration. The patient will be followed clinically to monitor periradicular responses.
Figure 1: Radiograph showing extra distal root

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Figure 2: Diagnostic radiograph showing five distinct canals

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Figure 3: Post-obturation radiograph

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  Discussion Top


Many dental clinicians have the perception that a given tooth will contain a pre-determined number of roots and/or canals. Careful evaluation of research material has, however, shown deviations from the normal tooth morphology. Presence of three roots five canals with five distinct apical opening is main feature of present case report. It is complex anatomy, which was quite challenging to locate, prepare, and obdurate. According to anatomically based nomenclature for the roots and root canals proposed by Albuquerque et al., root nomenclature in this case is M, MidDistal, D and root canal nomenclature is MesioLingual, MesioBuccal, MidDistal, Distobuccal, DB2. [11] Therefore, when root canal treatment is to be performed, the clinician should be aware that the root canal anatomy may be abnormal. Majority of mandibular first molars have two roots, one mesial and one distal. Their usual canal distribution is two canals in the mesial root and two canals in distal root. Review of case reports with the findings of three or more canals in distal root(s) of mandibular first molars [12] has been enlisted in [Table 1]. Mandibular molars can have an additional root known as radix molaris. This condition is considered to be unusual or dysmorphic root morphology. Detailed presentation of prevalence of radix molaris among different ethnic groups [13] has been shown in [Table 2].
Table 1: Review of case reports with the findings of three or more canals in distal root(s) of mandibular first
molars


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Table 2: Prevalence of radix molaris based on ethnicity

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  Conclusion Top


This case describes a mandibular first molar with an unusual number and arrangement of canals. It shows the presence of two canals in the mesial root, two canals in the distal root and one canal in the supplementary root with all canals having separate orifices in the pulp chamber floor. Each canal has its own independent course and terminates in a separate apical foramen. Dental clinicians should keep this possibility in mind while performing root canal treatment. Instrumentation is one of the key factors in the success of endodontic therapy; therefore, the clinician should be aware of the incidence of these extra canals in the mandibular first molar. The clinician can then perform a thorough examination of the pulp chamber to insure complete debridement of all canals. This increases the chance for long-term successful endodontic therapy.

 
  References Top

1.Ferraz JA, Pécora JD. Three-rooted mandibular molars in patients of Mongolian, Caucasian and Negro origin. Braz Dent J 1993;3:113-7.  Back to cited text no. 1
    
2.Sperber GH, Moreau JL. Study of the number of roots and canals in Senegalese first permanent mandibular molars. Int Endod J 1998;31:117-22.  Back to cited text no. 2
    
3.Vertucci FG, Haddix JE, Britto LR. Tooth morphology and access cavity preparation. In: Cohen S, Hargreaves KM, editors. Pathways of the Pulp. 9 th ed. St Louis, MO, USA: Mosby; 2006. p. 148-232.  Back to cited text no. 3
    
4.Vertucci FJ, Williams RG. Root canal anatomy of the mandibular first molar. J N J Dent Assoc 1974;45:27-8.  Back to cited text no. 4
    
5.Barker BC, Parsons KC, Mills PR, Williams GL. Anatomy of root canals. III. Permanent mandibular molars. Aust Dent J 1974;19:408-13.  Back to cited text no. 5
    
6.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. 6
    
7.Jacobsen EL, Dick K, Bodell R. Mandibular first molars with multiple mesial canals. J Endod 1994;20:610-3.  Back to cited text no. 7
    
8.Goel NK, Gill KS, Taneja JR. Study of root canals configuration in mandibular first permanent molar. J Indian Soc Pedod Prev Dent 1991;8:12-4.  Back to cited text no. 8
[PUBMED]    
9.DeGrood ME, Cunningham CJ. Mandibular molar with 5 canals: Report of a case. J Endod 1997;23:60-2.  Back to cited text no. 9
    
10.Walker RT, Quackenbush LE. Three-rooted lower first permanent molars in Hong Kong Chinese. Br Dent J 1985;159:298-9.  Back to cited text no. 10
    
11.Valerian Albuquerque D, Kottoor J, Velmurugan N. A new anatomically based nomenclature for the roots and root canals-part 2: Mandibular molars. Int J Dent 2012;2012:814789.  Back to cited text no. 11
    
12.Jain S. Mandibular first molar with three distal canals. J Conserv Dent 2011;14:438-9.  Back to cited text no. 12
[PUBMED]  Medknow Journal  
13.Parthasarthy B, Gowda M, Sridhara KS, Subbarya R. Four canalled and three rooted mandibular first molar (Radix Entomolaris)-report of two cases. J Dent Sci Res 2011;2:1-5.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2]



 

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Abstract
Introduction
Case Report
Discussion
Conclusion
References
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