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ARTICLE Table of Contents   
Year : 2005  |  Volume : 8  |  Issue : 1  |  Page : 67-70
Unusual pathways of pulp case report

1 Department of Operative Dentistry, Faculty of Dental Sciences, U.P. King George University of Dental Sciences, Lucknow, India
2 Department of Conservative Dentistry, Institute of Medical Sciences, Banaras Hindu University, Varanasi, India

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Recognition of unusual root canal anatomy plays a decisive role in the ultimate outcome of a particular en­dodontic case. This paper presents case reports of non-surgical management of permanent molars presenting with rare root canal configurations.

How to cite this article:
Shrivastava R, Barnwal H C, Chandra A, Wadhwani K K. Unusual pathways of pulp case report. J Conserv Dent 2005;8:67-70

How to cite this URL:
Shrivastava R, Barnwal H C, Chandra A, Wadhwani K K. Unusual pathways of pulp case report. J Conserv Dent [serial online] 2005 [cited 2022 Oct 7];8:67-70. Available from:

   Introduction Top

Effective root canal space debridement is the foundation for successful endodontic treatment. Understanding anatomic variations has a direct impact on the safe and efficient completion of difficult cases. Untreated root canals have been documented as a major cause of the endodontic failure [3] . The root canal anatomy of maxillary and mandibular permanent molars has long been investigated using both in-vitro and in-viva methodologies.

The maxillary second molar usually has three root canals .A fourth canal in the mesiobuccal root has been reported to occur less frequently than in maxillary first molar [5] .

Vertucci [8] examined 100 extracted maxillary second molars, and found 29% had four canals with two canals located in the niesiobuccal root.

Pomeranz and Fishelberg [6] by study of intraoral periapical radiographs reported occurence of two mesiobuccal canals with two distinct foramina in 24% of the maxillary second molars studied. Beatty [1] reported a case in which a permanent maxillary first molar was found to have five root canals with three canals in mesiobuccal root However, no case has been reported of the occurrence of three canals, in mesiobuccal root of maxillary second molar.

Mandibular first molar is more caries prone & is frequently indicated for root canal therapy. Mandibular first molar usually has two roots with two canals in the mesial and one or two canals in the distal root. A third root is found in some cases, mesially or distally (5.3%). Skidmore and Bjorndal [7] stated that approximately one third of mandibular first molars studied had four canals. But the mandibular first molar with five root canals, is rarely reported. Cohen and Burn's [2] have reported such a case with three root canals in mesial root of first mandibular molar.

This paper describes case reports of maxillary and mandibular molars presenting with unusual root canal anatomy.

   Case Report Top

A 40 year old male patient reported to the Department of Operative Dentistry, U.P. King George University of Dental Sciences, Lucknow for the evaluation of maxillary right second molar. The patient complained of continuous pain with tenderness on chewing. A preoperative radiograph was obtained which showed deep proximal caries distally. Clinical examination confirmed the pulpal involvement. After administration of local anaesthesia, access into the maxillary right second molar was prepared. An initial working length radiograph was exposed which revealed a second accessory curved canal in the mesiobuccal root. On exploration of the pulp chamber floor two more separate root canal orifices were identified in region of mesiobuccal root. Thorough biomechanical preparation was done. The tooth was dried with paper points and a cotton pellet was sealed into the pulp chamber with a reinforced zinc oxide eugenol filling material.

At the next appointment the three main canals, were obturated using lateral condensation technique while the two accessory mesiobuccal canals were obturated using silver cones. A final radiograph was taken. The permanent restoration was done at subsequent appointment.

   Case Report 2 Top

A male patient of age 22 years was referred to Department of Operative Dentistry, U.P. King George University of Dental Sciences, Lucknow with chief complaint of pain in right lower jaw with hot and sensitivity in right mandibular first molar. An intra oral periapical X-ray was taken to confirm the pulpal involvement. Once the diagnosis was made, the root canal treatment was initiated. The local anaesthesia was administered and pulp chamber was opened. There was a wide opening on distal side which was suggestive of two distal canals. All the four canals were located in the first appointment, pulp was completely debrided and cleaned. In the second appointment the patient complained of slight pain. Mesial canal were very narrow therefore the canal were prepared by using RC-prep (Premier Dental Product). The third opening was noticed while preparing the menial canals. Intra oral periapical X-ray was taken to confirm the third mesial canal. The canal was instrumented upto the full working length. The symptoms of patient disappeared after complete biomechanical preparation. The canals were obturated using lateral condensation technique. The final restoration was done in subsequent appointments.

   Conclusion Top

From the early work of Hess and Zurcher [4] to the most recent studies demonstrating anatomic complexities, of the root canal system, it has long been established that the root with a graceful tapering canal and a single apical foramen is the exception rather than the rule.

Various investigators [9],[10],[11] have shown accessory canals, multiple foramina,fins and deltas in most of the teeth. Hence, the clinician must approach the tooth to be treated assuming the presence of accessory root canals unless proven otherwise.[Figure 1],[Figure 2],[Figure 3],[Figure 4],[Figure 5],[Figure 6],[Figure 7],[Figure 8]

   References Top

1.Beatty R.G.: A five-canal maxillary first molar­a case report. J. Endod. 10, 155, 1984.  Back to cited text no. 1    
2.Cohen S & Burns R.C.: Pathways of pulp. Eighth Edition, page 211. Plate 7-XIlI-3, Moshy Pub.. 2002.  Back to cited text no. 2    
3.Grossmann L.I.: Endodontic failures. Dent. Clin. N. Am. 16, 59-70, 1972.  Back to cited text no. 3    
4.Hess W., Zurcher E.: The anatomy of the root canals of the teeth of the permanent and deciduous dentitions. New York, 1925, William Wood & Co.  Back to cited text no. 4    
5.Pineda, F. and Kuttler Y.: Mesiodistal and buccolingual roengenographic investigation of 7,275 root canals. Oral Sung. 33, 101-110. 1982.  Back to cited text no. 5    
6.Pomeranz, H.H. and Fishelberg G.: The secondary mesiobuccal canal of maxilary molars. J. Am. Dent. Assoc., 88. 119-124, 1974.  Back to cited text no. 6    
7.Skidmore A.E., Bjorndal A.M.: Root canal morphology of the human mandibular first molar. J. Oral Surg. 32. 778, 1971.  Back to cited text no. 7    
8.Vertucci F.J.: Root canal anatomy of the human permanent teeth. J. Oral Surg., 58, 589. 1984.  Back to cited text no. 8    
9.Vertucci F.J., Williams R.G.: Root canal anatomy of the mandibular first molar. J.N.J. Dent Assoc. 45, 27, 1974.  Back to cited text no. 9    
10.Weine F.S., Pasiewicz R.A., Rice R.T.: Canal configuration in the maxillary second molar using a clinically oriented in vitro method. J Endod 14, 207. 1988.  Back to cited text no. 10    
11.Weine F.S. et al. Canal configuration in the mesiobuccal root of the maxillary first molar and its endodontic significance. J. Oral Surg. 28.419, 1969.  Back to cited text no. 11    

Correspondence Address:
Rolly Shrivastava
Department of Operative Dentistry, Faculty of Dental Sciences, U.P. King George University of Dental Sciences, Lucknow
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-0707.42705

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  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]

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