Endodontic Management of Mandibular First Molar with Four Roots - A Rare Case Report with Clinical Management Guidelines

Authors

Shaikh Shahbaz, Department of Conservative Dentistry & Endodontics, Aligarh Muslim University, Aligarh, IndiaFollow
Huma Iftekhar, Department of Conservative Dentistry & Endodontics, Aligarh Muslim University, Aligarh, IndiaFollow
Sharique Alam, Department of Conservative Dentistry & Endodontics, Aligarh Muslim University, Aligarh, IndiaFollow
Zehra Shavez, Alshifa Hospital, New Delhi, IndiaFollow

Abstract

Mandibular molar is usually two rooted with one mesial and one distal root. Additional roots are rare which requires accurate diagnosis and a methodical and scrupulous endodontic treatment. Objective: This paper aims to report the endodontic management of an unusual case of a mandibular permanent first molar with four roots (two mesial & two distal) and provide a clinical guideline to detect and manage these variant cases. Case report: A 15-year-old boy reported with a deep carious lesion in the lower left first molar (#36). The apical root contour of #36 on an intraoral periapical radiograph taken in different angulations suggested the presence of extra roots. A Spiral Computed Tomographic scan with multiplanar three-dimensional reconstructed images confirmed a fourrooted mandibular molar. Endodontic treatment of #36 was planned based on a diagnosis of pulpal necrosis with symptomatic apical periodontitis. The pulp chamber floor was assiduously explored along the developmental root fusion line (DRFL) to guide a trapezoidal access cavity and expose two mesial and two distal orifices. Conclusion: The present case report highlights the successful endodontic treatment of an atypical four rooted mandibular first molar by following a systematic approach from diagnosis to its clinical management.

References

1. Singh S, Pawar M, Podar R, Kulkar ni G, Bhanushali N. Root canal morphology of South Asian Indian mandibular first, second, and third molar: A dye penetration and clearing study. J Conserv Dent. 2020; 23(3):284-8.
2. Souza-Flamini LE, Leoni GB, Chaves JF, Versiani MA, Cruz-Filho AM, Pécora JD, Sousa-Neto MD. The radix entomolaris and paramolaris: A micro-computed tomographic study of 3-rooted mandibular first molars. J Endod. 2014; 40(10):1616-21.
3. Różyło TK, Piskórz MJ, Różyło-Kalinowska IK. Radiographic appearance and clinical implications of the presence of radix entomolaris and radix paramolaris. Folia Morphologica. 2014; 73(4):449- 54.
4. Agarwal M, Trivedi HP, Mathur M, Goel D, Mittal S. The radix entomolaris and radix paramolaris: An endodontic challenge. J Contemp Dent Pract 2014; 15(4): 496-9.
5. Sinha DJ, Sinha AA. Four rooted mandibular first molar with four root canals: A rare case. Acta Sci Dent Sci. 2017; 1(2):38-41.
6. Morita M. Morphological studies on the roots of lower first molars in Japanese. Shika gakuho. Dent Sci Rep. 1990; 90(6):837-54.
7. Ahmed HA, Abu-bakr NH, Yahia NA, Ibrahim YE. Root and canal morphology of permanent mandibular molars in a Sudanese population. Int Endod J. 2007; 40(10):766-71.
8. Chourasia HR, Meshram GK, Warhadpande M, Dakshindas D. Root canal morphology of mandibular first permanent molars in an Indian population. Int J Dent. 2012; 2012:745152.
9. Torres A, Jacobs R, Lambrechts P, Brizuela C, Cabrera C, Concha G, Pedemonte ME. Characterization of mandibular molar root and canal morphology using cone beam computed tomography and its variability in Belgian and Chilean population samples. Imaging Sci Dent. 2015; 45(2):95-101.
10. Martins JNR, Gu Y, Marques D, Francisco H, Caramês J. Differences on the root and root canal morphologies between Asian and White ethnic groups analyzed by cone-beam computed tomography. J Endod. 2018; 44(7):1096-104.
11. Mashyakhy M, Chourasia HR, Halboub E, Almashraqi AA, Khubrani Y, Gambarini G. Anatomical variations and bilateral symmetry of roots and root canal system of mandibular first permanent molars in Saudi Arabian population utilizing cone- beam computed tomography. Saudi Dent J. 2019; 31(4):481-6.
12. Shah N, Bansal N, Logani A. Recent advances in imaging technologies in dentistry. World J Radiol. 2014; 6(10):794-807.
13. Friedman S, Moshonov J, Stabholz A. Five root canals in a mandibular first molar. Endod Dent Traumatol. 1986; 2(5):226-8.
14. Lee SJ, Jang KH, Spangberg LS, Kim E, Jung IY, Lee CY, Kum KY. Three-dimensional visualization of a mandibular first molar with three distal roots using computer-aided rapid prototyping. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2006; 101(5):668-74.
15. Purra AR, Mushtaq M, Robbani I, Farooq R. Spiral computed tomographic evaluation and endodontic management of a mandibular second molar with four roots. A case report and literature review. Iran Endod J. 2013; 8(2):69-71.
16. Kottoor J, Albuquerque DV, Velmurugan N, Sumitha M. Four-rooted mandibular first molar with an unusual developmental root fusion line: A case report. Case Rep Dent. 2012; 2012:237302.

Recommended Citation

Shahbaz, S., Iftekhar, H., Alam, S., & Shavez, Z. Endodontic Management of Mandibular First Molar with Four Roots - A Rare Case Report with Clinical Management Guidelines. J Dent Indones. 2022;29(1): 67-72