|Year : 2021 | Volume
| Issue : 1 | Page : 116-119
Permanent maxillary first molar with a single root and a single canal diagnosed with cone-beam computed tomography scanning: Case report
Rohit Nair1, Sruthy R Kartha2, Sandhya Khasnis1, Jayaprakash Patil1
1 Department of Conservative Dentistry and Endodontics, PMNM Dental College and Hospital, Bagalkot, Karnataka, India
2 Department of Conservative Dentistry and Endodontics, Mahe Institute of Dental Sciences, Mahe, Kerala, India
|Date of Submission||05-Dec-2019|
|Date of Decision||26-Dec-2019|
|Date of Acceptance||10-Feb-2020|
|Date of Web Publication||09-Jan-2021|
Dr. Rohit Nair
Department of Conservative Dentistry and Endodontics, PMNM Dental College and Hospital, Bagalkot, Karnataka
Source of Support: None, Conflict of Interest: None
Failure of endodontic treatment most commonly occurs due to inability of the clinician to locate the extra root and canal present; however, at times, there could also be a fewer number of roots and canals present, especially in molar teeth. A 33-year-old healthy female reported with a chief complaint of tooth pain in her upper left first molar. Clinical examination revealed a fractured restoration and deep proximal carious lesion of the tooth. The tooth was tender on percussion and negative to thermal and electric pulp testing. Radiographic examination revealed a single root and a single canal. A diagnosis of asymptomatic irreversible pulpitis with symptomatic apical periodontitis was made. Nonsurgical endodontic treatment was performed. The patient was asymptomatic at a 6-month follow-up with no abnormalities detected radiographically. The use of cone-beam computed tomography scan was very helpful in confirming the root and canal morphology of the treated tooth.
Keywords: Maxillary molar, morphological variations, root canal treatment, single canal, single root
|How to cite this article:|
Nair R, Kartha SR, Khasnis S, Patil J. Permanent maxillary first molar with a single root and a single canal diagnosed with cone-beam computed tomography scanning: Case report. Saudi Endod J 2021;11:116-9
|How to cite this URL:|
Nair R, Kartha SR, Khasnis S, Patil J. Permanent maxillary first molar with a single root and a single canal diagnosed with cone-beam computed tomography scanning: Case report. Saudi Endod J [serial online] 2021 [cited 2021 Jan 19];11:116-9. Available from: https://www.saudiendodj.com/text.asp?2021/11/1/116/306605
| Introduction|| |
It is mandatory for every clinician to have thorough knowledge about the root and canal morphology in order to perform a successful endodontic therapy. Awareness about the variations in the root and canal morphology also plays a vital role in successful management of cases with aberrant root morphology. In majority of the cases, the maxillary first molar has shown the presence of three roots and four canals, whereas the maxillary second molar has shown three roots and three canals in most of the cases. However, maxillary molars with unusual root and canal morphology exist, and this must always be taken into consideration by the clinician before starting the endodontic procedure.
Conventional preoperative radiographs do help in identification of this aberrant root morphology; however, cone-beam computed tomography (CBCT) is a three-dimensional (3D) modality which confirms the aberrant root and canal morphology. CBCT imaging is an invaluable tool which shows the root canal system in three dimensions with superior sensitivity relative to 2D radiographic modalities.
It produces geometrically accurate 3D scans of the maxillofacial skeleton at a considerably lower radiation dose than conventional CT; hence, CBCT was opted over the conventional CT scan.,
This case report describes the endodontic management of permanent maxillary first molar with an unusual root canal configuration of a single root and a single canal and also confirms the presence of a single root and a single canal in maxillary second molar using CBCT scanning.
| Case Report|| |
A 33-year-old female in good health reported to endodontic clinic with the chief complaint of tooth pain in her upper left back portion of the jaw for few days. The pain was aggravated on consuming cold water and on mastication. The patient also gave a history of intermittent pain with respect to the same region for the past 2 months. The pain was continuous and throbbing for the past 2 days, and clinical examination revealed a fractured proximal restoration with respect to the upper left first molar. A deep proximal carious lesion was also seen associated with the fractured restoration of the same tooth. The tooth was tender on percussion. Thermal and electric pulp testing gave a negative response for the maxillary left first molar. A preoperative radiograph of the tooth was taken, which revealed a mesio-occlusal radiolucency approaching the pulp space [Figure 1]a. Another important feature to be noted in the preoperative radiograph was the presence of unusual root morphology for both the maxillary first and second molars; both seemed to have a single root and a single canal. From the available information, a diagnosis of asymptomatic irreversible pulpitis with symptomatic apical periodontitis was made, and the patient was advised that an endodontic treatment is necessary for the maxillary left first molar.
|Figure 1: (a) Preoperative radiograph of the maxillary left first molar. (b) Clinical photograph showing a single, wide root canal orifice. (c) Working length determination. (d) Master cone. (e) Postoperative radiograph|
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After the administration of local anesthesia, the tooth was isolated using a rubber dam. The restoration was removed and caries was cleaned, and then, access cavity preparation was done. Thorough clinical examination of the pulpal floor revealed the presence of a single wide canal at the center of the floor [Figure 1]b; champagne bubble test was performed under an operating microscope (SERWELL MEDI-EQUIPMENTS PVT LTD, Tamil Nadu, India) which helped in ruling out the presence of any other root canal orifice. Working length was determined with the help of an apex locator (Root ZX, Japan); radiographs were then taken at different angulations to confirm the length obtained [Figure 1]c.
Biomechanical preparation was then done using crown-down shaping technique with the help of hand files and ProTaper rotary files (Dentsply Maillefer). Irrigation was done gently between the instrumentation using 2.5% sodium hypochlorite solution, taking care not to force the irrigant beyond the apex. Final irrigation was accomplished using 17% ethylenediaminetetraacetic acid liquid, and the canal was dried thoroughly before obturation. A master cone radiograph was then taken [Figure 1]d, and obturation was done by the cold lateral compaction of gutta-percha using AH plus sealer (Dentsply Maillefer). The final postobturation restoration of the tooth was then done using composite filling material (Tetric N Ceram, Ivoclar Vivadent), and a postoperative radiograph was taken [Figure 1]e.
To confirm the unusual presence of a single root and canal, a CBCT imaging (NewTom GIANO Italy, Prima Diagnostics-Bangalore, India Pvt. Ltd) of maxillary left first and second molars was done using dental software Dentyscan 3D. The CBCT scan report confirmed the presence of a single root and a single canal with both maxillary left first and second molars [Figure 2] and [Figure 3]. The patient was kept under observation, and a follow-up radiograph after 6 months revealed no signs of root canal failure [Figure 4], and the patient was asymptomatic during the follow-up period.
|Figure 2: Cone-beam computed tomography scan image of the maxillary left first molar|
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|Figure 3: Cone-beam computed tomography scan image of the maxillary left second molar|
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|Figure 4: Six-month follow-up radiograph of the maxillary left first molar|
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| Discussion|| |
It is mandatory for all the clinicians to have a thorough knowledge and awareness about the morphological variations in the root canal system to perform a successful endodontic therapy. However, morphological variations such as presence of a single root and a single canal in the maxillary first and second molars are not commonly seen.,, Perforation and excessive grinding of sound tooth structure are the iatrogenic errors done by a clinician in search of extra canals; these errors can be minimized if the practitioner has knowledge about such unusual morphological variations. Preoperative radiographs of different angulations and thorough examination of the pulp-chamber floor under magnification are essential aids to confirm these aberrant morphological variations.,
Case reports on variations in the number of root canals with respect to the maxillary molars have been published, but very little documentation is available on the presence of a single root and a single canal in both the maxillary first and second molars of the same patient. A study conducted by Neelakantan et al. on the root and canal morphology of the maxillary first and second molars in an Indian population revealed 0.9% of the teeth with a single root but none of them with a single root canal, which confirms the rare incidence of such cases.
In the present case, the clinical examination of the pulp-chamber floor under dental operating microscope helped in identifying the presence of a single canal with maxillary left first molar. To confirm the presence of a single root and canal, a CBCT scan of both maxillary molars was planned. The CBCT scan reports confirmed the presence of a single root and a single canal with maxillary left first and second molars.
Canal variation most of the time occurs bilaterally. The CBCT image of the contralateral maxillary second molar showed a single root and a single canal; however, the contralateral maxillary first molar had two roots and two root canals [Figure 5] and [Figure 6].
|Figure 5: Cone-beam computed tomography scan image of the maxillary right first molar|
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|Figure 6: Cone-beam computed tomography scan image of the maxillary right second molar|
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Thus, in rare cases like this, where we have a doubt regarding the number of roots and canals present, CBCT can be used as a confirmatory diagnostic aid.
| Conclusion|| |
This case report presents an unusual morphological variation of a single root and a single canal with the maxillary first and second molars, confirmed with the help of CBCT. Even though such cases occur very rarely, the clinician must have awareness about them for performing the endodontic therapy successfully.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ahuja P, Ballal S, Velmurugan N. Endodontic management of maxillary second molar with a single root and a single canal diagnosed with cone-beam computed tomography scanning. Saudi Endod J 2012;2:100-3. [Full text]
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.
] [Full text]
Bansal P, Mishra P, Nikhil V, Raj S, Jain A. Maxillary second molar with single root and single canal: A case series. Endodontology 2019;31:129-32. [Full text]
Alsaeed A, Jamleh A. Root canal treatment of maxillary first molar with vertucci type V diagnosed by cone beam computed tomography. Saudi Endod J 2019;9:231-4. [Full text]
Patel S, Dawood A, Ford TP, Whaites E. The potential applications of cone beam computed tomography in the management of endodontic problems. Int Endod J 2007;40:818-30.
Matherne RP, Angelopoulos C, Kulild JC, Tira D. Use of cone-beam computed tomography to identify root canal systems in vitro
. J Endod 2008;34:87-9.
Cleghorn BM, Christie WH, Dong CC. Root and root canal morphology of the human permanent maxillary first molar: A literature review. J Endod 2006;32:813-21.
Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol 1984;58:589-99.
Malagnino V, Gallottini L, Passariello P. Some unusual clinical cases on root anatomy of permanent maxillary molars. J Endod 1997;23:127-8.
Barbizam JV, Ribeiro RG, Tanomaru Filho M. Unusual anatomy of permanent maxillary molars. J Endod 2004;30:668-71.
Gopikrishna V, Bhargavi N, Kandaswamy D. Endodontic management of a maxillary rst 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.
Ioannidis K, Lambrianidis T, Beltes P, Besi E, Malliari M. Endodontic management and cone-beam computed tomography evaluation of seven maxillary and mandibular molars with single roots and single canals in a patient. J Endod 2011;37:103-9.
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.
Peikoff MD, Christie WH, Fogel HM. The maxillary second molar: Variations in the number of roots and canals. Int Endod J 1996;29:365-9.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]