Aberrant Canal Configuration of the Maxillary First Molar: A Case Report

Knowledge of both the normal and abnormal anatomies of theroot canal system dictates the parameters for the execution ofroot canal therapy and this can directly affect the outcome ofthe endodontic therapy . Many unusual canalconfigurations and anomalies in the maxillary first molarshave been documented in case reports and several studies.There are numerous variations in the canal number andconfiguration in maxillary molars . In maxillary firstmolars, mesiobuccal roots tend to have more variations in thecanal system followed by the distobuccal root, whereas thepalatal root has the least.

The maxillary first molar most commonly has three or fourcanals, with one canal in both the palatal and distobuccal rootsand one or two in the mesiobuccal root. Most of theclinical literature on the fourth canal in maxillary molarsreports an additional mesiobuccal canal (MB2). In addition tothese studies, the literature cites the variation in the palatalroot of the maxillary molars as a single root with 2 separateorifices, 2 separate canals, and 2 separate foramina; 2 separateroots, each with 1 orifice, 1 canal, and 1 foramen; and a singleroot with 1 orifice, a bifurcated canal, and 2 separate foramen,with a trifurcation at the apical third in the palatal canal. Theincidence of two root canals in the palatal root of maxillarymolars has been reported to be 2- 5.1%.This case report intensifies the complexity of maxillarymolar variation and is intended to reinforce the clinician’sawareness of the rare morphology of root canals. It presentsendodontic therapy of a permanent maxillary, first molar with2 canals in a single palatal root.

A 23-year-old male presented to the Department ofConservative Dentistry and Endodontics, with the chiefcomplaint of pain on chewing associated with the leftmaxillary first molar. On clinical examination revealed a deepcarious lesion in the same tooth. The tooth was painful onpercussion and gave exaggerated response to thermal and theelectric pulp tests. The preoperative radiographic evaluationof the involved tooth indicated caries, which approximated thepulp with the normal root canal anatomy and the widening ofthe periodontal ligament space . After thoroughclinical and radiographic examination, a diagnosis of chronicirreversible pulpitis with apical periodontitis was made andthe patient was prepared for endodontic treatment. Thepatient’s medical history was found to be non-contributory.The tooth was anaesthetized by using 2% lidocaine with1:100,000 adrenaline. After isolation by using a rubber dam, aconventional endodontic access opening was made.