Case Report

Type I canal configuration in a single rooted maxillary

first molar diagnosed with an aid of cone beam
computed tomographic technique: A rare case report
Naveen Chhabra, Kiran P Singbal, Tamanna Marwah Chhabra1
Departments of Conservative Dentistry and Endodontics and 1Prosthodontics, K M Shah Dental College and Hospital, Sumandeep
Vidyapeeth, Pipariya, Vadodara, Gujarat, India

Abstract
Anatomic variations in maxillary molars are frequent. These deviations are also one of the major cause for endodontic treatment
failure owing to inadequate cleaning, shaping and sealing of root canal system. Diagnosis of such aberrations using newer
imaging techniques like cone beam computed tomography is firmly advocated. The present paper highlights the root canal
treatment of a rare case of type I canal morphology diagnosed with an aid of cone beam computed tomographic technique.
Keywords: Cone beam computed tomography; maxillary first molar; single canal; single root

INTRODUCTION complaint of severe pain in the left upper back region

Adequate cleaning, shaping and obturation of the root
canal system are keys to long-term endodontic success.
It is absolutely essential to visualize the pulp chamber
in three dimensions to facilitate successful access cavity
preparations, thereby providing unimpeded access to the
apical foramen. This is especially critical in teeth with
aberrant morphology.
Morphologic variations in permanent maxillary molars that
have been frequently reported pertain to the presence of
additional roots, canals or fused roots[1,2] and “C”-shaped
canal.[3] The occurrence of a single root in the maxillary
molar is rare, and even rarer in case of permanent maxillary
first molar.[4-6] A case of single root in the deciduous
maxillary first molar is also reported.[7]
In the light of the above context, the present paper
highlights the diagnosis and treatment of a relatively rare
case of single rooted permanent maxillary first molar with
type I root canal configuration.
CASE REPORT
A 25-year-old male patient reported to the Department
of Conservative Dentistry and Endodontics with the chief
of the mouth since 3 days. Pain was continuous and
aggravated with the intake of hot and cold beverages.
Clinical examination revealed deep mesial caries
approximating pulp with respect to tooth # 26. The tooth
was not tender to percussion and palpation. Pulp vitality
testing using an electric pulp tester (Parkell, Farmingdale,
NY, USA) showed exaggerated response lasting for several
minutes. Further, the maxillary lateral incisors were
missing and the deciduous right maxillary first molar was
overretained. Intraoral periapical radiograph of tooth # 26
revealed deep caries involving the pulp space [Figure 1a].
Also, a single root with single canal was seen in relation to
26 and 27. Based on the clinical and radiographic findings,
the diagnosis of acute irreversible pulpitis was made and
patient was advised root canal treatment in relation to
tooth # 26. After obtaining patient’s consent, an emergency
pulpotomy was performed at the same visit under local
anesthesia. In order to confirm the apparent finding of the
IOPA radiograph, the patient was referred for CBCT imaging
of tooth 26 with 3D reconstruction. The results of the CBCT
showed the presence of a single root with the Vertucci’s
type I canal configuration,[8] and the same was observed
for tooth 27 [Figure 2]. Thereafter, the root canal treatment
was initiated. The tooth was isolated using rubber dam and
access preparation was modified to completely de-roof the
pulp chamber, which showed the presence of a single wide
root canal orifice. Working length was calculated using

Address for correspondence: Access this article online

Dr. Naveen Chhabra, Department of Conservative Dentistry and Quick Response Code:
Endodontics, K M Shah Dental College and Hospital, Sumandeep Website:
www.jcd.org.in
Vidyapeeth, Pipariya, Vadodara, Gujarat - 391 760, India.
E-mail: drnaveenchhabra@yahoo.com
Date of submission : 21.02.2013 DOI:
Review completed : 24.04.2013 10.4103/0972-0707.114346
Date of acceptance : 28.05.2013

Journal of Conservative Dentistry | Jul-Aug 2013 | Vol 16 | Issue 4 385

Chhabra et al.: Single rooted maxillary first molar diagnosed using CBCT

an electronic apex locator (Root ZX IITM, Morrita, Tokyo,
Japan) as well as the radiographic method. Working length
radiograph also suggested positioning of endodontic files
in a single canal [Figure 1b]. The coronal shaping was carried
out using Gates Glidden burs (Dentsply, New Delhi, India)
in crown down manner followed by step back technique
with an apical enlargement up to size 55 K file (Dentsply)
along with copious irrigation with 5% sodium hypochlorite
solution. The canal was finally rinsed with 17% EDTA
solution and dried with absorbent paper points (Dentsply,
New Delhi, India). The root canal was obturated using a
resin-based endodontic sealer (AH PLUSTM; Dentsply) and
laterally condensed gutta percha followed by restoration
of access preparation with silver amalgam. Posttreatment
radiograph showed the adequate sealing of the root canal
system and the patient was asymptomatic [Figure 1c]. The
patient was advised complete coverage restoration and
referred to the Department of Prosthodontics for the same.
DISCUSSION
Routine preoperative intraoral periapical radiographs
are essential before initiating endodontic treatment
due to its usefulness in identifying variations from the
normal, thereby influencing the treatment plan. In specific
instances, it may be helpful to supplement with periapical
radiographs taken at varying horizontal angulations.
However, because the radiographs have several inherent
shortcomings due to it being a two-dimensional image of
a three-dimensional object, erroneous interpretations are
very much possible due to the superimposition of multiple
anatomic structures questioning its reliability. Recent
imaging tools like spiral CT and CBCT have emerged as
valuable tools in the field of endodontics due to its accuracy,
reliability and three-dimensional imaging capabilities. In
CBCT, a cone-shaped beam rotates 360° around the patient
to obtain a volume and captures the image in the form of
three-dimensional isotropic voxels. These multiple voxels
are further combined with the help of viewing software
and a 3D image is reconstructed.[9] Its uses in endodontics
include identifying dental anatomic variations such as
additional roots and/or canals, fused roots, identification
of horizontal/vertical fracture line in the tooth root and
management of internal and external resorptive defects.[10]

a b c
Figure 1: (a) Preoperative radiograph, (b) working length radiograph and (c) posttreatment radiograph

a b

c d
Figure 2: CBCT image showing various tomographic views at the middle third root level of #26. (a) Axial view shows single root
as well as canal in # 26, (b) cross-sectional view showing the presence of single root and canal, (c) panoramic view again showing
the single root and canal in # 26 (also note the missing maxillary lateral incisors and presence of retained deciduous maxillary
molar on the right side) and (d) three-dimensional reconstruction image showing the single root throughout the root length

386 Journal of Conservative Dentistry | Jul-Aug 2013 | Vol 16 | Issue 4

 Chhabra et al.: Single rooted maxillary first molar diagnosed using CBCT
Moreover, it helps to avoid overzealous removal of tooth
tissue during access preparation and exploration of root
canal orifices.
Presence of extra canal is more frequent rather than the
presence of fused/less number of canals, especially in
the cases of permanent maxillary first molars. Immense
disparity in the root/root canal morphology of permanent
maxillary molars of Indian origin exists as compared with
Caucasian and Mongoloid traits, as reported in a computed
tomographic research. The variations reported in the
population were the presence of single root and canal,
two separate roots, two fused roots, three fused roots and
four separate roots.[11] Also, the incidence of single root
in the maxillary first molar in the Korean population has
been found to be 0.25% in a recent computed tomographic
research.[12]
In the present case, several possibilities needed to be ruled
out. The first possibility was that the bilateral maxillary first
molars were congenitally absent and the tooth in question
was maxillary second molar. However, the likelihood of this
being the case was ruled out considering the positioning
of tooth in the arch vis-a-vis the radiographic anatomic
landmarks such as the location of the maxillary sinus and
the zygomatic arch. Also, axial inclination of the tooth and
lack of tilt precluded the possibility of migration of the
maxillary second molar into the position of the maxillary
first molar.
Detailed analysis of the 3D reconstruction image at the
cervical, middle and apical regions of the root excludes
the possibility of multiple fused roots due to the lack of
external root eminences on the buccal aspect. Moreover,
there is absolutely no indication of any pulp canal space
other than the one that is well centered within the confines
of the root. Thus, it is safe to assume that the tooth in
question is definitely maxillary first molar with single root
and canal.
To conclude, the present case highlights the need to develop
Journal of Conservative Dentistry | Jul-Aug 2013 | Vol 16 | Issue 4
excellent observation skills on the part of the operator to
identify any aberrations from the normal within the tooth,
possibly with the use of advance imaging techniques,
especially in the presence of anomalies in dentition.
REFERENCES
1. Shin SJ, Park JW, Lee JK, Hwang SW. Unusual root canal anatomy in
maxillary second molars: Two case reports. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2007;104:e61-5.
2. Gopikrishna V, Reuben J, Kandaswamy D. Endodontic management of a
maxillary first molar with two palatal roots and a single fused buccal root
diagnosed with spiral computed tomography: A case report. Oral Surg
Oral Med Oral Pathol Oral Radiol Endod 2008;105:e74-8.
3. Kottoor J, Velmurugan N, Ballal S, Roy A. Four-rooted maxillary first
molar having C-shaped palatal root canal morphology evaluated using
cone-beam computerized tomography: A case report. Oral Surg Oral
Med Oral Pathol Oral Radiol Endod 2011;111:e41-5.
4. Shigli A, Agrawal A. Permanent maxillary first molar with single root and
single canal: A case report of a rare morphology. J Indian Soc Pedod
Prev Dent 2010;28:121-5.
5. Gopikrishna V, Bhargavi N, Kandaswamy D. Endodontic management
of a maxillary first molar with a single root and a single canal diagnosed
with the aid of spiral CT: A case report. J Endod 2006;32:687-91.
6. de la Torre F, Cisneros-Cabello R, Aranguren JL, Estévez R,
Velasco-Ortega E, Segura-Egea JJ. Single-rooted maxillary first molar
with a single canal: Endodontic retreatment. Oral Surg Oral Med Oral
Pathol Oral Radiol Endod 2008;106:e66-8.
7. Jeevanandan G, Subramanian E, Muthu MS. Single-rooted primary first
molars. Indian J Dent Res 2012;23:104-6.
8. Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral
Surg 1984;58:589-99.
9. Dayal C, Sajjan SG. Imaging solutions in endodontics: Cone beam
computed tomography-A review. Endodontol 2012;23:167-70.
10. Cotton TP, Geisler TM, Holden DT, Schwartz SA, Schindler WG.
Endodontic applications of cone-beam volumetric tomography. J Endod
2007;33:1121-32.
11. Neelakantan P, Subbarao C, Ahuja R, Subbarao CV, Gutmann JL.
Cone-beam computed tomography study of root and canal morphology
of maxillary first and second molars in an Indian population. J Endod
2010;36:1622-7.
12. Kim Y, Lee SJ, Woo J. 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.
J Endod 2012;38:1063-8.
How to cite this article: Chhabra N, Singbal KP, Chhabra TM.
Type I canal configuration in a single rooted maxillary first molar
diagnosed with an aid of cone beam computed tomographic
technique: A rare case report. J Conserv Dent 2013;16:385-7.
Source of Support: Nil, Conflict of Interest: None declared.
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