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 Iran Endod J
 v.8(1); Winter 2013
 PMC3570973

Iran Endod J. 2013 Winter; 8(1): 29–32.
Published online 2013 Jan 20.
PMCID: PMC3570973

Two-Rooted Maxillary First Molars with
Two Canals: A Case Series
Sahar Shakouie,1 Hadi Mokhtari,1,* Negin
Ghasemi,1 and Seddigheh Gholizadeh1
Author information ► Article notes ► Copyright and License information ►

four [10]. and five [11] roots and unusual morphology of root canal systems within individual roots. Other variations for maxillary first molars include one [9]. 8. debride. Introduction Tooth root internal morphology is often complex and greatly influences endodontic treatment. this implies that inability to detect. 3]. Cases with five [12] and six [13] root canals or with a C-shaped canal configuration [14] have also been reported earlier.1% [7. the mesiobuccal root has two root canals due to its wide buccolingual dimension and associated concavities and a single canal for distobuccal and palatal roots [5. 2. successful endodontic treatment depends on proper cleaning. In fact. Maxillary first molars have the most complicated root and canal morphology of the maxillary dentition. and filling of the root canal system. There is a wide range of variations in the literature with respect to the number of canals in each root and the number of roots. Martinez-Berna and Ruiz-Badanelli [15] reported three cases in which the maxillary first molars involved six root . and obturate all the existing canals is a major cause of endodontic failure [1. Abstract Go to: 1. 9].This article has been cited by other articles in PMC. 6]. It is now generally accepted that the most common form of maxillary first molar has three roots and four canals [4]. therefore. their anatomy has been evaluated extensively in various studies. The incidence of two mesiobuccal canals has been reported to range from 18% to 96. shaping.

with a chief complaint of spontaneous toothache in her maxillary right first molar for the previous two days. who reported the endodontic treatment of maxillary molars with two palatal roots [16]. Such an anatomic variation has been reported in a limited number of studies for second maxillary molar. two in the distobuccal and one in the palatal roots). Tehran. The root structure was not clearly demonstrated on radiograph (Figure 1A). The tooth was diagnosed with irreversible pulpitis with apical periodontitis. Palatine root canal variations were well established by Stone et al. The patient’s medical history was unremarkable. After removal of caries the pulp chamber was completely rinsed with normal saline.canals (three in the mesiobuccal. The tooth was sensitive to temperature variations and electric pulp test and tender to vertical percussion. .. Case Report Case 1 A 56-year-old female presented to the Department of Endodontics. Exploration of the root canal orifices resulted in finding one buccal and one palatal orifice. Iran) and a rubber dam was placed. Two-rooted maxillary first molar with two canals has rarely been reported. Local anesthesia was administered with 2% lidocaine and 1:80000 epinephrine (DarouPakhsh. Tabriz Faculty of Dentistry. Go to: 2. The present case series reports three maxillary first molars with fusion of the two roots and two canals [17].

A) Radiographic images of First maxillary molar with two-canal.Figure 1. Italy) and under dental operating microscope (DOM) (Seiler Revelation. Carl Zeiss SpA. C) The master apical cones confirmed the measured lengths. Switzerland) and their lengths were determined by a Root-ZX apex locator (Morita. B) Access cavity reveals one buccal and one palatal canal. Tokyo. B) Two orifices were detected in the floor of the tooth. E) 12 month follow-up Figure 3. C) Working length determination. Malliefer. MO). E) One-year recall The buccal orifice was relatively large (Figure 1B).5 magnification of prismatic loupes (Zeiss Eyemag Pro S. Arese. The root canals were explored with a K-Flexofile ISO20 (Dentsply. D) Final radiograph. D) Post-operative radiograph after treatment. Japan) and confirmed with a periapical radiograph (Figure 1C). B) Two orifices were showed in the access . No extra orifice was found by further exploration at ×4. The morphology was confirmed by further radiographic examination as initial radiographs were unclear. A) Initial radiograph of first maxillary molar with one buccal root. St Louis. A) Preoperative radiograph of two-canalled first maxillary molar. Figure 2.

Case 2 A 24-year-old female was referred to the Department of Endodontics.06 taper using the crown-down technique. La-Chaux-de-Fonds. and 17% EDTA. irrigation was performed using normal saline. for endodontic treatment of maxillary right first molar.04 and 0. The canals were then further prepared with RaCe rotary files (FKG. Palpation of the buccal and palatal aspects of the tooth did not reveal any tenderness. which was tender to percussion (Figure 2A). A clinical examination revealed a carious maxillary right first molar. Maillefer) and obturated using cold lateral compaction of gutta-percha (Dentsply. Konstanz. The patient’s medical history was noncontributory. Access cavity was then sealed with a temporary restorative material. History revealed intermittent pain in the same tooth with hot and cold stimuli for the past two weeks. The tooth was not mobile and periodontal .06 tapers to 1 mm short of the radiographic apex up to file #35 with 0.. The patient was referred to the Department of Operative Dentistry for restorative treatment. Germany). 2.5% sodium hypochlorite solution. Dentsply. The pain intensified by thermal stimuli and on mastication. Dentaire. Obturation quality was confirmed radiographically (Figure 1D). During root canal preparation. The canals were dried with absorbent paper points (Dentsply. C) The master cones were inserted at the one buccal and one palatal canal. E) One-year.cavity image. Switzerland) with 0. D) Post-operative radiograph after treatment. Tabriz Faculty of Dentistry. Maillefer) and AH26 resin sealer (Maillefer..

The root structure was not clearly demonstrated on radiograph (Figure 3A). After removal of caries. The working lengths were determined in the same manner as described for case 1 (Figure 2C). Compared to typical buccal orifices diameters in maxillary first molars a large buccal orifice was found (Figure 3B). Further exploration was performed using a loupe and microscope. Then the other orifice was found in the palatal aspect. Radiographic examination revealed the presence of a deep amalgam restoration and caries in the mesial aspect (Figure 3A). Case 3 A 32-year-old female was referred to the Department of Endodontics.probing around the tooth was within physiological limits. One orifice was found in the buccal aspect. The working lengths were determined in the same manner as described . access cavity was formed completely and rinsed with normal saline. After removal of the coronal amalgam and caries. The morphology was confirmed by radiographic examination. No other orifice was found even by exploration with a loupe and microscope (Figure 2B). This morphology was confirmed by radiographic examination. Tabriz Faculty of Dentistry. it had a large diameter compared to typical buccal orifices in maxillary first molars. The tooth was sensitive to temperature and electric pulp test but was not tender to percussion. the canals were prepared and obturated as described for case 1. The patient was referred to the Department of Operative Dentistry for restorative treatment (Figure 2D). the roof of the pulp chamber was removed completely and rinsed with normal saline. for endodontic treatment of her maxillary left first molar. however none were found.

including radiographs. Many studies have evaluated the root and canal morphology of the maxillary first molar because this tooth often presents with complex morphology that often render treatment difficult [4. All three cases showed favorable results in one-year follow ups (Figures 1E.3E3E). Discussion The root and root canal morphology of teeth varies greatly according to reported literature [18-28]. Fusion of two buccal roots is one of the most common aberrations of maxillary molars. and scanning electron microscopy have been used for this purpose [29]. A total of 0. Go to: 3.2% of second maxillary molars have been reported to have this variation [30]. clinical evaluations. .for case 1 (Figure 3C). Presence of additional root canals has been reported and discussed by several authors. It has been shown that the total number of canals found and endodontically treated does not correspond to the number of canals actually existing in a tooth. the canals were prepared and obturated as described for case 1. The patient was referred to the Department of Operative Dentistry for restorative treatment (Figure 3D). This . . magnification. It is therefore important to understand the variables that affect detection and treatment of root canals. 29].2E.2E. and a variety of study methods. Detection of all the root canals is difficult due to the various factors involved. tooth sectioning.4% of first maxillary molars and 2. Prior knowledge of root and canal anatomy facilitates precise detection of all tooth root canals during endodontic treatment [29]. dye injection.

Schilder H. The location and morphology of root canals should be evaluated by radiography before and during root canal treatment. 32]. Careful examination of radiographs and the internal anatomy of teeth are essential for successful treatment. Go to: 4. [PubMed] . Ghasemi N. Conflict of Interest: None declared. Go to: Footnotes Please cite this paper as: Shakouie S. Root canal morphology should be examined further during treatment by evaluation of radiographs taken from different horizontal angles. Two-Rooted Maxillary First Molars with Two Canals: A Case Series. Mokhtari H. The use of a preoperative radiographs and additional radiographic views with 20-degree mesial or distal angulations are good techniques for the assessment of root canal morphology and anatomy [31. 2013. Gholizadeh S. 1967:723–44.should be considered in endodontic diagnoses and treatments.8(1): 29-32. Go to: References 1. Iran Endod J. Dent Clin North Am. Filling root canals in three dimensions. Conclusion Clinicians must have adequate knowledge about root canal morphology and its variations.

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.. 2013]  Root and canal morphology of Burmese maxillary molars.See all. 2012]  Evaluation of root canal morphology of human primary molars by using CBCT and comprehensive review of the literature. 2006] See reviews.[J Endod.[Acta Odontol Scand. Articles from Iranian Endodontic Journal are provided here courtesy of Iranian Center for Endodontic Research Formats:  Article |  PubReader |  ePub (beta) |  PDF (381K) |  Citation Share  Facebook  Twitter  Google+ Save items Add to FavoritesView more options Similar articles in PubMed  Maxillary first molar with two root canals.[Int Endod J. .[Int Endod J. 2016]  C-shaped root canal in a maxillary first molar: a case report..[Sultan Qaboos Univ Med J.. 2001]  Morphology of maxillary first and second molars analyzed by cone-beam computed tomography in a korean population: variations in the number of roots and canals and the incidence of fusion.

. PubMed  Use of a microscope during endodontic treatment seems to have helped locating se. 2014 Dec.40(12):2087-94...148(8):e121. doi: 10. Winter 2013.2017... 2017 Aug. .034.1016/j.06. Three root canals in the mesiobuccal root of maxillary molars: case reports and literature review..07.]  A Review on Root Anatomy and Canal Configuration of the Maxillary Second Molars[Iranian Endodontic Journal. J Endod..2014..1016/j. Use of a microscope during endodontic treatment seems to have helped locating second mesiobuccal root in maxillary first molars that needed retreatment.adaj..006. doi: 10. 2015] See all..]  Treatment of a Maxillary First Molar with Two Palatal Roots[Iranian Endodontic Journal. Epub 2017 Jul 11.Cited by other articles in PMC  Canal Configuration of Mesiobuccal Roots in Permanent Maxillary First Molars in Iranian Population: A Systematic Review[Journal of Dentistry (Tehran. Armed Forces . J Am Dent Assoc.joen. Links  PubMed  Taxonomy Recent Activity ClearTurn Off  Two-Rooted Maxillary First Molars with Two Canals: A Case Series Two-Rooted Maxillary First Molars with Two Canals: A Case Series Iranian Endodontic Journal. 2016]  Management of a maxillary first molar with morphological aberration using spiral computed tomography[Medical Journal.. Instrumentation Effic. 2017]  Accuracy of Cone-Beam Computed Tomography in Determining the Root Canal Morphology of Mandibular First Molars[Iranian Endodontic Journal.. Epub 2014 Oct 16. 8(1)29  Three root canals in the mesiobuccal root of maxillary molars: case reports and .. PubMed  Influence of Access Cavity Design on Root Canal Detection.

doi: 10. Please review our privacy policy. 2017 Jul 21. pii: S0099-2399(17)30582-4. Root Morphology and Canal Configuration of First and Second Maxillary Molars in a Selected Iranian Population: A Cone-Beam Computed Tomography Evaluation.. doi: 10.1016/j.[J Conserv Dent. 2011]  Mandibular first premolar with three roots: a case report.05. 2002] Support CenterSupport Center xternal link.[J Endod. 2006]  Morphologic study of the maxillary molars.[Braz Dent J.006.. 1992]  Bilateral root or root canal aberrations in a dental school patient population.v12i3.22037/iej. [Epub ahead of print] PubMed  Root Morphology and Canal Configuration of First and Second Maxillary Molars in . 2006]  C-shaped root canal configuration in maxillary first molars.[Iran Endod J. Iran Endod J. 1994]  Review C-shaped root canal in a maxillary first molar: a case report. NLM NIH . 2017 Summer. PubMed See more.joen. Part II: Internal anatomy.2017.12(3):288-292. J Endod.[J Endod. 2012]  Review Root and root canal morphology of the human permanent maxillary first molar: a literature review..Influence of Access Cavity Design on Root Canal Detection.[Int Endod J.  Spiral computed tomographic evaluation and endodontic management of a mandibular first molar with three distal canals.13708.. Instrumentation Efficacy.[Int Endod J. and Fracture Resistance Assessed in Maxillary Molars.

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