Endodontic management of a maxillary second molar with three roots and seven canals using cone-beam computed tomography

Abstract

The present case highlights the endodontic management of a maxillary second molar with three roots and seven canals. Root canal treatment was performed for the maxillary second molar diagnosed with symptomatic irreversible pulpitis. During the procedure under magnification, extra canals were detected in the mesiobuccal root. Cone-beam computed tomography (CBCT) evaluation confirmed four canals in the mesiobuccal root with Vertucci's Type XXI (4-1) pattern. The distobuccal root exhibited two canals with Vertucci's Type III (1-2-1) configuration. The palatal canal was single and large. A 4 year follow-up revealed satisfactory clinical and radiographic findings. Magnification and CBCT allow us to explore possible anatomic variations with insights to tackle such situations clinically.

Keywords: Cone beam computed tomography; magnification; maxillary second molar; seven canal system.

Figure 1

(A and B) Preoperative radiograph of tooth 17, 16. (C and F) Working length radiographs at different angulations. (D) Magnified view of the access showing three mesial canal orifices, the fourth one (*) only faintly visible. (E) Magnified view of the access opening after CBCT evaluation and shaping showing four mesial canal orifices. (G) Master Cone radiograph. (H and I) Post-obturation radiographs at different angulations. (J-L) Radiographs after one, two, and four years of follow up, respectively

Figure 2

(A and B) CBCT images of right maxillary arch showing serial axial sections at different levels. (a-F) Enlarged axial section images of tooth 17 at different levels showing Vertucci's Type XXI (4-1) pattern in the mesiobuccal root and Vertucci's TYPE III (1-2-1) pattern in the distobuccal root (white arrows). (G- J) Post-obturation CBCT Images of the enlarged axial sections of tooth 17 at different levels confirming the complete obturation of the diagnosed canal pattern (black arrows).