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do Carmo WD, Verner FS, Aguiar LM, Visconti MA, Ferreira MD, Lacerda MFLS, Junqueira RB. Missed canals in endodontically treated maxillary molars of a Brazilian subpopulation: prevalence and association with periapical lesion using cone-beam computed tomography. Clin Oral Investig 2020; 25:2317-2323. [PMID: 32875385 DOI: 10.1007/s00784-020-03554-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 08/26/2020] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To evaluate the prevalence of missed canals in endodontically treated maxillary molars through cone-beam computed tomography (CBCT) images and to verify their association with the presence of periapical lesions. MATERIAL AND METHODS Three oral radiologists evaluated 633 maxillary molars in CBCT exams regarding number of roots, number of root canals, number of missed canals, anatomic identification of missed canals, presence of periapical lesions, and root location of the periapical lesions. Data were statistically analyzed at a 5% significance level. RESULTS Descriptive statistical analysis showed that among 395 first molars, 218 had at least one missed canal, and 186 (46.5%) had a missed canal and periapical lesion simultaneously. Of these, 72.4% (134) of the missed canals were only mesiobuccal 2 (MB2). Among 238 s molars evaluated, 121 presented at least one missed canal, and 104 (43.6%) had a missed canal and periapical lesion simultaneously. Of these, 81.7% (85) of the missed canals were only MB2. The chi-squared test showed an association between the presence of missed canals and periapical lesions for 1st and 2nd maxillary molars. Teeth that presented a missed canal showed an odds ratio (OR) of 2.57 (p < 0.0001) of being associated with a periapical lesion. Missed canal occurrence was positively related to the number of root canals (z = 13.06, p < 0.0001), meaning when the number of root canals is higher, there is a higher probability of missed canal occurrence. According to the model calculated prediction, for a one-unit increase in the number of canals, the probability of missed canals increases by 4.22%. CONCLUSIONS It was concluded that MB2 was the most frequently missed canal, associated with the presence of periapical lesions in endodontically treated maxillary molars. CLINICAL RELEVANCE Professionals' negligence of anatomical root variations has been contributed to the high prevalence of missed canals, leading to failures in endodontic treatment. Their association with periapical lesion occurrence emphasizes the importance of correct detection and instrumentation of these canals.
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Affiliation(s)
- Weslley Duarte do Carmo
- Department of Dentistry, Federal University of Juiz de Fora, Campus GV (UFJF-GV), Av. Dr. Raimundo Rezende, 330, Centro, Sala 301, Governador Valadares, Minas Gerais, 35010-177, Brazil
| | - Francielle Silvestre Verner
- Department of Dentistry, Federal University of Juiz de Fora, Campus GV (UFJF-GV), Av. Dr. Raimundo Rezende, 330, Centro, Sala 301, Governador Valadares, Minas Gerais, 35010-177, Brazil
| | - Larisse Martins Aguiar
- Department of Dentistry, Federal University of Juiz de Fora, Campus GV (UFJF-GV), Av. Dr. Raimundo Rezende, 330, Centro, Sala 301, Governador Valadares, Minas Gerais, 35010-177, Brazil
| | - Maria Augusta Visconti
- School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Matheus Diniz Ferreira
- School of Dentistry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Mariane Floriano Lopes Santos Lacerda
- Department of Dentistry, Federal University of Juiz de Fora, Campus GV (UFJF-GV), Av. Dr. Raimundo Rezende, 330, Centro, Sala 301, Governador Valadares, Minas Gerais, 35010-177, Brazil
| | - Rafael Binato Junqueira
- Department of Dentistry, Federal University of Juiz de Fora, Campus GV (UFJF-GV), Av. Dr. Raimundo Rezende, 330, Centro, Sala 301, Governador Valadares, Minas Gerais, 35010-177, Brazil.
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Ordinola-Zapata R, Martins JNR, Plascencia H, Versiani MA, Bramante CM. The MB3 canal in maxillary molars: a micro-CT study. Clin Oral Investig 2020; 24:4109-4121. [PMID: 32382930 DOI: 10.1007/s00784-020-03284-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 04/14/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To assess the internal and external morphologies of the mesiobuccal (MB) root of maxillary molars presenting a third root canal (MB3), using micro-computed tomography (micro-CT). MATERIAL AND METHODS Two-hundred and sixty-five extracted maxillary first and second molars with different root configurations were imaged in a micro-CT scanner at 19.6-μm pixel size. Sixteen teeth presenting MB3 canal were selected and evaluated regarding root configuration, minimal dentine thickness 2 mm under the furcation area, canal configuration of the MB root, MB3 canal morphology (location, independent or confluent orifice, and anatomy types), and the apical anatomy (aspect ratio, number of accessory canals and foramina, presence of isthmus, and independent MB3 foramen). RESULTS Overall, a high variability in canal configuration was detected in the MB root. MB3 canal was observed in 10 maxillary first molars and 6 maxillary second molars (n = 16). Minimal dentine thickness related to the MB3 canal at the coronal third was smaller than that of the MB1 canal. A complex internal anatomy comprising 13 different root canal configurations was observed. A high number of independent MB3 orifices at the pulp chamber floor was observed in the first molars (7 out of 10 teeth), while most of the specimens (n = 14) showed a confluent anatomy of the MB3 canal. A varied number of accessory canals and foramina were observed. At the apical third, isthmus could be observed in 6 specimens, while an independent MB3 foramen was present in 37.5% of the MB roots. CONCLUSIONS MB3 canal is a rare anatomical variation present in maxillary first and second molars. Its presence can be associated to a complex internal anatomy of the MB root which includes the presence of isthmuses and multiple accessory canals and foramina at the apical third, but also a thin dentine thickness at the coronal third and a confluent anatomy of the MB3 with the other main canals.
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Affiliation(s)
- Ronald Ordinola-Zapata
- Department of Endodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil. .,Division of Endodontics, University of Minnesota School of Dentistry, 515 Delaware Street S.E, Minneapolis, MN, 55455, USA.
| | - Jorge N R Martins
- Faculdade de Medicina Dentária, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Universidade de Lisboa, Lisbon, Portugal.,Faculdade de Medicina Dentária, Centro de Estudo de Medicina Dentária Baseada na Evidência (CEMDBE), Universidade de Lisboa, Lisbon, Portugal.,Department of Endodontics, Faculdade de Medicina Dentária, Universidade de Lisboa, Lisbon, Portugal
| | - Hugo Plascencia
- Endodontic Postgraduate Program, CUCS, University of Guadalajara, Guadalajara, Mexico
| | - Marco A Versiani
- Dental Specialty Centre, Brazilian Military Police, Fortaleza, Minas Gerais, Brazil
| | - Clovis M Bramante
- Department of Endodontics, Bauru Dental School, University of São Paulo, Bauru, São Paulo, Brazil
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Nayak G, Singh KK, Shekhar R. Endodontic management of a maxillary first molar with three roots and seven root canals with the aid of cone-beam computed tomography. Restor Dent Endod 2015; 40:241-8. [PMID: 26295029 PMCID: PMC4534730 DOI: 10.5395/rde.2015.40.3.241] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 04/13/2015] [Indexed: 11/26/2022] Open
Abstract
Variation in root canal morphology, especially in maxillary first molar presents a constant challenge for a clinician in their detection and management. This case report describes the successful root canal treatment of a three rooted right maxillary first molar presenting with three canals each in the mesiobuccal and distobuccal roots and one canal in the palatal root. The clinical detection of this morphologic aberration was made using a dental operating microscope, and the canal configuration was established after correlating and computing the clinical, radiographic and cone-beam computed tomography (CBCT) scan findings. CBCT images confirmed the configuration of the canals in the mesiobuccal and distobuccal roots to be Al-Qudah and Awawdeh type (3-2) and type (3-2-1), respectively, whereas the palatal root had a Vertucci type I canal pattern. This report reaffirms the importance of careful examination of the floor of the pulp chamber with a dental operating microscope and the use of multiangled preoperative radiographs along with advanced diagnostic aids such as CBCT in identification and successful management of aberrant canal morphologies.
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Affiliation(s)
- Gurudutt Nayak
- Department of Conservative Dentistry and Endodontics, Institute of Dental Sciences, Bareilly, UP, India
| | - Kamal Krishan Singh
- Department of Conservative Dentistry and Endodontics, Kanti Devi Dental College and Hospital, Mathura, UP, India
| | - Rhitu Shekhar
- Department of Conservative Dentistry and Endodontics, Kanti Devi Dental College and Hospital, Mathura, UP, India
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Endodontic management of a maxillary molar with three mesiobuccal canals. Case Rep Dent 2014; 2014:320196. [PMID: 25505997 PMCID: PMC4254077 DOI: 10.1155/2014/320196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 10/19/2014] [Accepted: 11/03/2014] [Indexed: 01/03/2023] Open
Abstract
It is imperative that the clinician should have comprehensive knowledge about the normal anatomy and its variations of the teeth as the deviations from the usual are very common. An increased awareness of unusual anatomy and a better understanding of the root canal system guide the clinician in accurate diagnosis and treatment of such variations in order to achieve a successful endodontic outcome. The maxillary first molar has been shown to have a wide variation in respect to the number of canals specifically noted in the mesiobuccal root. The current case report shows the successful management of a maxillary molar in which the mesiobuccal root had three canals.
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Ahmad IA, Al-Jadaa A. Three root canals in the mesiobuccal root of maxillary molars: case reports and literature review. J Endod 2014; 40:2087-94. [PMID: 25443283 DOI: 10.1016/j.joen.2014.07.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Revised: 07/28/2014] [Accepted: 07/28/2014] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The knowledge of root canal anatomy is essential to ensure a successful outcome of surgical and nonsurgical root canal treatment. The aims of this article were to present 2 cases of maxillary molars with 3 mesiobuccal root canals and to review the available literature on this anatomic variation. METHODS The first case described a nonsurgical root canal treatment of tooth #16 in a 29-year-old man with the aid of a dental operating microscope. In the second case, an extracted maxillary right first molar was scanned by a micro-computed tomographic system and reconstructed 3-dimensionally using modeling software. RESULTS In both cases, the mesiobuccal root had 3 canals (type 3-2 in case I and type 3-3 in case II), whereas the distobuccal and palatal roots had a single canal. The literature review showed that the overall incidence of 3-canaled mesiobuccal roots in maxillary molars ranged from 1.3%-2.4% and that the most common root canal configuration was type 3-2. CONCLUSIONS Clinicians should always anticipate the presence of extra canals in maxillary molars and use all the available tools to locate and treat these.
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Affiliation(s)
- Ibrahim Ali Ahmad
- Restorative Dentistry Department, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Kingdom of Saudi Arabia.
| | - Anas Al-Jadaa
- Clinic for Preventive Dentistry, Periodontology and Cariology, University Dental Center, University of Zurich, Zurich, Switzerland
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Badole GP, Warhadpande MM, Shenoi PR, Lachure C, Badole SG. A rare root canal configuration of bilateral maxillary first molar with 7 root canals diagnosed using cone-beam computed tomographic scanning: a case report. J Endod 2013; 40:296-301. [PMID: 24461422 DOI: 10.1016/j.joen.2013.09.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 08/30/2013] [Accepted: 09/03/2013] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The complexity of the root canal system of maxillary molars presents a constant challenge in the diagnosis and treatment of these teeth. This case report describes the importance of a surgical operating microscope and cone-beam computed tomographic (CBCT) imaging. METHODS Root canal treatment of a left maxillary first molar with 3 roots and 7 canals was successfully performed. Seven canals were identified with the help of a surgical operating microscope and CBCT imaging. CBCT images also confirmed the 3 roots and 7 canals in the right maxillary first molar. RESULTS CBCT images confirmed a type IV canal pattern in the distal and palatal root, whereas the mesial root had a type VIII canal pattern. CONCLUSIONS The use of a surgical operating microscope and CBCT imaging helps the clinician to diagnose unusual anatomy of a tooth and facilitate successful endodontic treatment.
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Affiliation(s)
- Gautam P Badole
- Department of Conservative Dentistry and Endodontics, VSPM's Dental College and Research Center, Nagpur, India.
| | - Manjusha M Warhadpande
- Department of Conservative Dentistry and Endodontics, Government Dental College and Hospital, Nagpur, India
| | - Pratima R Shenoi
- Department of Conservative Dentistry and Endodontics, VSPM's Dental College and Research Center, Nagpur, India
| | | | - Shital G Badole
- Department of Conservative Dentistry and Endodontics, VSPM's Dental College and Research Center, Nagpur, India
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Arora A, Acharya SR, Saraswathi MV, Sharma P, Ather A. Dilemmas pertaining to three canals in the mesiobuccal root of a maxillary second molar: a case report. Restor Dent Endod 2013; 38:172-7. [PMID: 24010085 PMCID: PMC3761127 DOI: 10.5395/rde.2013.38.3.172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/11/2013] [Accepted: 06/17/2013] [Indexed: 11/11/2022] Open
Abstract
The mesiobuccal root of the maxillary molars is well known to pose a hindrance during endodontic therapy. Presented here is a case of a maxillary left second molar where three canals were located in its mesiobuccal root with the use of visual and diagnostic aids. Difficulties encountered during the process of unveiling the tooth's internal anatomy were discussed. The dilemmas encountered pertained to the root canal configuration, the nomenclature of the extra canals, and the justification for the presence of a third canal. The root canal configuration of 3-2-1 was confirmed for the mesiobuccal root using information gained from clinical, radiographic, and multi-detector computed tomography (MDCT) scan findings. This case demonstrates the need for efforts to locate extra canals in the mesiobuccal root of the maxillary molars as their internal anatomy remains a mystery.
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Affiliation(s)
- Ankit Arora
- Department of Conservative Dentistry and Endodontics, Manubhai Patel Dental College, Hospital and Oral Research Institute, Vadodara, India
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Gupta S, Jaiswal S, Arora R. Endodontic management of permanent mandibular left first molar with six root canals. Contemp Clin Dent 2012; 3:S130-3. [PMID: 22629055 PMCID: PMC3354780 DOI: 10.4103/0976-237x.95124] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
The endodontic treatment of a mandibular molar with aberrant canal configuration can be diagnostically and clinically challenging. This case report presents the treatment of a mandibular first molar with six root canals, of which three canals were located in the mesial root and three in distal root. Third canals were found between the two main root canals. This case presents a rare anatomic configuration and points to the importance of expecting and searching for additional canals.
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Affiliation(s)
- Sachin Gupta
- Department of Conservative Dentistry and Endodontics, Subharti Dental College, NH-58 Delhi Haridwar Bypass Road, Subhartipuram, Meerut, Uttar Pradesh, India
| | - Shikha Jaiswal
- Department of Conservative Dentistry and Endodontics, Subharti Dental College, NH-58 Delhi Haridwar Bypass Road, Subhartipuram, Meerut, Uttar Pradesh, India
| | - Rohit Arora
- Department of Conservative Dentistry and Endodontics, Subharti Dental College, NH-58 Delhi Haridwar Bypass Road, Subhartipuram, Meerut, Uttar Pradesh, India
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A new anatomically based nomenclature for the roots and root canals-part 1: maxillary molars. Int J Dent 2011; 2012:120565. [PMID: 22216031 PMCID: PMC3246733 DOI: 10.1155/2012/120565] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 09/19/2011] [Indexed: 11/23/2022] Open
Abstract
Numerous terminologies have been employed in the dental literature to describe the roots and root canal systems of maxillary molars. This multiplicity in naming of roots and canals makes the reader susceptible to misinterpretation and confusion. No consensus thus far has been arrived at for defining the names of roots and root canals in maxillary molars, including their various morphological aberrations. The anatomical relation of roots and their root canals were identified and were subsequently named based on definite sets of criteria. A new method for identification and naming of roots and root canal anatomy in maxillary molars, based on their root and canal relationship, was formulated and is presented in this paper. The nomenclature makes certain essential modifications to the traditional approach to accommodate naming of the various aberrations presented in the maxillary molars. A simple, yet extensive, nomenclature system has been proposed that appropriately names the internal and external morphology of maxillary molars.
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Maxillary first molar with seven root canals diagnosed with cone-beam computed tomography scanning: a case report. J Endod 2010; 36:915-21. [PMID: 20416446 DOI: 10.1016/j.joen.2009.12.015] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Revised: 11/30/2009] [Accepted: 12/08/2009] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The purpose of this article was to emphasize the importance of having a thorough knowledge about the root canal anatomy. METHODS This case report presents the endodontic management of a maxillary first molar with three roots and seven canals. The clinical detection of the seven canals was made using a surgical operating microscope and confirmed using cone-beam computed tomography (CBCT) scanning. RESULTS CBCT axial images showed that both the palatal and distobuccal root have a Vertucci type II canal pattern, whereas the mesiobuccal root showed a Sert and Bayirli type XV canal configuration. CONCLUSION This report describes and discusses the variation in canal morphology of maxillary first molar and the use of latest adjuncts in successfully diagnosing and negotiating them.
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Garg AK, Tewari RK, Kumar A, Agrawal N. Endodontic treatment of a maxillary first molar having three mesiobuccal canals with the aid of spiral computed tomography: a case report. J Oral Sci 2010; 52:495-9. [DOI: 10.2334/josnusd.52.495] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Baratto Filho F, Zaitter S, Haragushiku GA, de Campos EA, Abuabara A, Correr GM. Analysis of the internal anatomy of maxillary first molars by using different methods. J Endod 2009; 35:337-42. [PMID: 19249591 DOI: 10.1016/j.joen.2008.11.022] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2008] [Revised: 11/27/2008] [Accepted: 11/28/2008] [Indexed: 12/29/2022]
Abstract
The success of endodontic treatment depends on the identification of all root canals so that they can be cleaned, shaped, and obturated. This study investigated internal morphology of maxillary first molars by 3 different methods: ex vivo, clinical, and cone beam computed tomography (CBCT) analysis. In all these different methods, the number of additional root canals and their locations, the number of foramina, and the frequency of canals that could or could not be negotiated were recorded. In the ex vivo study, 140 extracted maxillary first molars were evaluated. After canals were accessed and detected by using an operating microscope, the teeth with significant anatomic variances were cleared. In the clinical analysis, the records of 291 patients who had undergone endodontic treatment in a dental school during a 2-year period were used. In the CBCT analysis, 54 maxillary first molars were evaluated. The ex vivo assessment results showed a fourth canal frequency in 67.14% of the teeth, besides a tooth with 7 root canals (0.72%). Additional root canals were located in the mesiobuccal root in 92.85% of the teeth (17.35% could not be negotiated), and when they were present, 65.30% exhibited 1 foramen. Clinical assessment showed that 53.26%, 0.35%, and 0.35% of the teeth exhibited 4, 5, and 6 root canals, respectively. Additional root canals were located in this assessment in mesiobuccal root in 95.63% (27.50% could not be negotiated), and when they were present, 59.38% exhibited 1 foramen. CBCT results showed 2, 4, and 5 root canals in 1.85%, 37.05%, and 1.85% of the teeth, respectively. When present, additional canals showed 1 foramen in 90.90% of the teeth studied. This study demonstrated that operating microscope and CBCT have been important for locating and identifying root canals, and CBCT can be used as a good method for initial identification of maxillary first molar internal morphology.
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Poorni S, Kumar R, Indira R. Canal complexity of a mandibular first molar. J Conserv Dent 2009; 12:37-40. [PMID: 20379439 PMCID: PMC2848812 DOI: 10.4103/0972-0707.53341] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2008] [Revised: 12/01/2008] [Indexed: 11/19/2022] Open
Abstract
The endodontic treatment of a mandibular molar with aberrant canal configuration can be diagnostically and technically challenging. This case report presents the treatment of a mandibular first molar with five root canals, of which three were located in the mesial root. A third canal was found between the mesiobuccal and mesiolingual root canals. The morphological pattern of separate apical terminations of three mesial root canals with separate orifices, as manifested in this case, is a rare one.
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Affiliation(s)
- S Poorni
- Department of Conservative Dentistry and Endodontics, Ragas Dental College, Chennai, India
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Maxillary first molar with an unusual morphology: report of a rare case. ACTA ACUST UNITED AC 2008; 106:e62-5. [DOI: 10.1016/j.tripleo.2008.07.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2008] [Accepted: 07/27/2008] [Indexed: 12/12/2022]
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