Endodontic Treatment of a Maxillary First Molar With Two Separate Palatal Roots: A Case Report

Abstract

Maxillary first molars exhibit considerable anatomical variation, with a single palatal root being the most common occurrence, while two palatal roots are notably less frequent. This case report details the endodontic treatment of a maxillary first molar with two separate palatal roots. It highlights the critical importance of recognizing these anatomical variations and their unique challenges during endodontic procedures. This report emphasizes the essential role of advanced diagnostic methods, such as cone-beam computed tomography, and the use of microscopic techniques in identifying and treating such cases.

Keywords: cone- beam computed tomography; dental operating microscope; extra palatal root; maxillary first molar; root canal treatment.

Figure 1. The preoperative periapical radiograph of the upper right first molar.

The tooth has four roots, indicated as follows: the mesiobuccal root (marked by a red arrow), the distobuccal root (yellow arrow), the mesiopalatal root (green arrow), and the distopalatal root (blue arrow). Notably, the palatal roots are widely spaced. The apices of the mesiobuccal, distobuccal, and mesiopalatal roots exhibit a distal curvature, collectively resembling the shape of cow horns.

Figure 2. The cross-sectional (A) and sagittal (B) views of cone-beam computed tomography (CBCT).

The cross-sectional view (A) of CBCT reveals that the upper right first molar has four roots, indicated as follows: the mesiobuccal root (marked by a red arrow), the distobuccal root (yellow arrow), the mesiopalatal root (green arrow), and the distopalatal root (blue arrow). In contrast, the upper left first molar (white arrow) has two buccal roots and a single palatal root. The sagittal view (B) of CBCT shows that the mesiopalatal root (green arrow) and the distopalatal root (blue arrow) of the upper right first molar are widely spaced apart.

Figure 3. The intraoral photograph.

The upper right first molar has a sixth cusp near the mesial side of Carabelli's cusp (indicated by the yellow arrow). In contrast, the opposing upper left first molar only has Carabelli's cusp and does not exhibit a sixth cusp.

Figure 4. Microscopic photograph.

The pulp floor is shown with the mesiobuccal (MB) and distobuccal (DB) root canal orifices.

Figure 5. Microscopic photograph.

The pulp floor is shown with two palatal root canal orifices, mesiopalatal(MP) and distopalatal (DP), being notably distant from each other.

Figure 6. The periapical radiograph for working length confirmation.

The working length of each canal is accurately determined by inserting a K-file into the canal and confirming its length.

Figure 7. The postoperative radiograph of the upper right first molar.

All four root canals are properly filled, with the two buccal canals exhibiting severe curvature.