This started out to be a normal case. Upon access there was a lot of bleeding on the pulpal floor. I used a slow round to smooth out the pulpal floor under the microscope. I was able to see a total of 5 canals and treat them.
To investigate properly the possibility of additional canals, the dentist should:
- Take additional off-angle radiographs or CBCT;
- Ensure adequate “straight-line” access to improve visibility and make sure the canal is centered in the root;
- Examine the pulpal floor for “lines” to areas where additional canals may be located;
- Remove a small amount of tooth structure or the dentinal shelf, which often may occlude a canal orifice.
The frequency of a maxillary first molar with two palatal canals is very low, about 1%. I may not ever see another one in my lifetime.
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| Figure 1: Pre-op image showing the palatal root looking calcified. | Figure 2: Post-op image showing the canals: MB1 (mesial buccal), MB2 (second mesial buccal), DB (disto buccal), P1 (first palatal canal), P2 (second palatal canal). |
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| Figure 3: Post-op inverted view showing all 5 canals. | Figure 4: Post-op normal view showing all 5 canals. |
This case contributes to our understanding of the complexity of the root canal morphology found in maxillary first molars. Although such cases occur infrequently, dentists should be aware of them when considering endodontic treatment of a maxillary first molar.
For more information, see “Root and Root Canal Morphology of the Human Permanent Maxillary First Molar: A Literature Review,” Journal of Endodontics, vol. 32, no. 9, pp. 813–821, 2006, by B. M. Cleghorn, W. H. Christie, and C. C. S. Dong.
What would you have done? Email me at dr.short@yahoo.com, or visit our related posts on Facebook at facebook.com/DentistryToday/ or facebook.com/rootcanaldoc.
Rico D. Short, DMD, attended the Medical College of Georgia (MCG) School of Dentistry to attain a Doctor of Dental Medicine degree in 1999. In 2002, he earned his postdoctorate degree in endodontics from Nova Southeastern University and became a Diplomate of the American Board of Endodontics in 2009. Dr. Short is an expert consultant in endodontics to the Georgia Board of Dentistry and assistant clinical professor at the Dental College of Georgia in Augusta. Dr. Short also has published articles in several magazines and peer-reviewed journals including Dentistry Today, Inside Dentistry, Rolling Out Magazine, Upscale Magazine, and the Journal of Endodontics. He has lectured throughout the United States and the Caribbean. Dr. Short is endorsed by the American Association of Endodontists speakers bureau, and his private practice, Apex Endodontics PC, is located in Smryna, Ga. Dr. Short also has authored a book, Getting to the Root of Your Problem: 365 Days of Inspirational Thinking.
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