Clinical Management of Unusual Configuration in a Lower Second Molar with Four Roots - 2 Years Follow Up

Author(s): Ghadah A Altaroti, Khalaf A Alwasi, Raif R Marqoshi, Tarek Ezzeldin

The present case describes a diagnosed rare anatomic configuration of a lower left second molar with anatomical variation of having four roots and severely curved MB canal in a 23-year old Saudi female, this patient was referred to the Endodontic Department at Dammam Medical Complex from PHCC for its management .The patient's medical history was noncontributory. Analysis of the cone beam computed tomography (CBCT) with aid of Dental operating microscope confirmed the presence of four roots for tooth #37. Cleaning and shaping of all canals were performed using ProTaper universal nickel-titanium rotary instruments with copious irrigation of 2.5% sodium hypochlorite (NaOCl) solution and 17% ethylene diamine tetra-acetic acid (EDTA). Obturation was performed using continuous wave compaction of Gutta-percha and AH Plus resin sealer. The tooth was finally temporized with cavit and glass ionomer filling, later the patient was referred to Prosthodontic Department for final coronal seal and restoration. Clinical and radiographic examination of the patient after 2 years revealed complete healing of the periapical lesion.

Conclusion: The clinical relevance and the main purpose of this paper is to report the successful treatment of an uncommon four-rooted mandibular second molar, with four roots and four root canals with severely curved MB canal. The canal morphology was confirmed with CBCT and successfully managed. To have a successful treatment outcome, clinical detection of all canals is crucial, primordial awareness of all the anatomical variations which can exist and constitute a formidable challenge in endodontics, but finally team work with advanced diagnostic aid is a corner stone for its accomplishment as management of severely curved canals require advanced equipments and experienced hands.