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JOURNAL OF ENDODONTICS
VOL. 17, NO. 6, JUNE1991
Copyright 9 1991 by The American Association of Endodontists
CASE REPORT Maxillary First Molar with Three Palatal Canals Marston Wong, DDS, MS
A case report is presented involving the endodontic treatment of a maxillary first molar with an unusual morphological variation of the palatal root. The palatal root canal system was characterized by a single canal orifice, a trifurcation on the apical one third of the root and three separate foramina.
It is essential to find all of the root canals in an endodontic case in order to ensure long-term treatment success (1). It is imperative that the clinician be cognizant of possible morphological variations of teeth in order to treat all of the root canals that may be present. A number of reports (2-6) have addressed the morphological variations of the root canal system of the palatal root of the maxillary molar. Thews et al. (2) have reported two cases of unusual variations of the root canal system in the palatal root of maxillary first molars. The first case had two distinct palatal roots with corresponding root canals; the second case had a single palatal root with two distinct root canal orifices and canals that appeared to terminate in a common apical foramen. Harris (2), Benenati (3), and Bond et al. (4) have reported cases of maxillary molars with a single palatal root containing two separate orifices and root canals. Stone and Stoner (5) and Cecic et al. (6) have reported cases in which the palatal root contained one orifice, a bifurcated canal, and two foramina. The following clinical case is a report of a variation of the palatal root canal anatomy of a maxillary molar thus far not reported.
i
I i
FiG 1. Radiograph of tooth 14 with indistinct image of the palatal root.
CASE R E P O R T FIG 2. Radiograph of initial length files in place. File in palatal canal is
A 22-yr-old white male was referred to the endodontic service for completion of root canal therapy of the maxillary left first molar. Six weeks previously, after a carious exposure of this tooth, the pulp was partially extirpated, and a formocresol cotton pellet and temporary seal placed. The patient's medical history was noncontributory. Clinical examination revealed the tooth to be asymptomatic. The radiographic examination disclosed an indistinct image of the palatal root attributed to the superimposition of the zygomatic arch (Fig. 1). Access into the maxillary molar
off-centered.
was prepared; only three canals were located. Length determination was established (Fig. 2); the canals were instrumented and filled with laterally condensed gutta-percha and Roth 801 Elite grade sealer (Roth Drug Co., Chicago, IL). The postoperative radiograph (Fig. 3) revealed the palatal root canal to have a trifurcation at the apical one third. The entire 298
Vol. 17, No. 6, June 1991
FIG 3. Radiograph o f poorly obturated palatal root canal system revealing trifurcation at the apical one third.
Palatal Root with Three Canals
299
F~G 5. Postoperative radiograph showing the final root canal filling.
DISCUSSION In retrospect, the indistinct image of the palatal root on the preoperative radiograph should have cautioned the author to the possibility of a second canal. In addition, the initial length determination radiograph revealed the file in the palatal root to be off-centered (Fig. 2). Slowey (8) has stressed the need for further exploration when such findings occur. Location of a third canal was found with the aid of the first postoperative radiograph which serendipitously revealed the trifurcated root canal system. The assumption that this tooth had only one palatal canal stresses the importance that morphological variations are usually unexpected and when they occur we must be quick to reevaluate our procedure and deal with the anomaly as it presents.
FiG 4. Radiograph of length files at time of retreatment, with three files in the palatal root.
root canal filling was removed immediately and the patiem rescheduled for further instrumentation. At the second appointment, with the aid of the postoperative radiograph indicating a trifurcation of the palatal root canal system, the three separate canals could be distinguished. Figure 4 shows the five instruments in the root canals. After canal preparation, the tooth was dried with paper points and a cotton pellet was sealed in the pulp chamber with IRM (L. D. Caulk Co., Division of Dentsply, Milford, DE). At the next appointment, three #30 gutta-percha points were fitted and placed into the palatal canals with Roth 801 Elite grade sealer. Lateral condensation with accessory points was used to obturate the palatal canals. The mesiobuccal and distobuccal canals were obturated in a similar manner. A final radiograph was taken (Fig. 5).
The views expressed in this article are those of the author and do not reflect the official policy or position of the Department of Defense or the United States government. Dr. Wong is chief and mentor of endodontics, Advanced Educational Program in general dentistry (2 yr), Ft. Hood, TX. Address requests for reprints to COL Marston Wong, USA Dentac, Fort Hood, TX 76544-5063.
References 1. Fahid A, Taintor JF. Maxillary second molar with three buccal roots. J Endodon 1988;14:181-3. 2. Thews ME, Kemp WB, Jones CR. Aberrations in palatal root and root canal morphology of two maxillary first molars. J Endodon 1979;5:94-6. 3. Harris WE. Unusual root canal anatomy in a maxillary molar. J Endodon 1980;6:573-5. 4. Benenati FW. Maxillary second molar with two palatal canals and a palatogingival groove. J Endodon 1985;11:308-10. 5. Bond JL, Hartwell G, Portell FR. Maxillary first molar with six canals. J Endodon 1988;14:256-60. 6. Stone LH, Stoner WF. Maxillary molars demonstrating more than one palatal root canal. Oral Surg 1981 ;51:649-52. 7. Cecic P, Hartwell G, Bellizzi R. The multiple root canal system in the maxillary first molar: a case report. J Endodon 1982;8:113-5. 8. Slowey RR. Root canal anatomy--road map to successful endodontics. Dent Clin North Am 1979;23:555-73.
JOURNAL OF ENDODONTICS
VOL. 17, NO. 6, JUNE1991
Copyright 9 1991 by The American Association of Endodontists
CASE REPORT Maxillary First Molar with Three Palatal Canals Marston Wong, DDS, MS
A case report is presented involving the endodontic treatment of a maxillary first molar with an unusual morphological variation of the palatal root. The palatal root canal system was characterized by a single canal orifice, a trifurcation on the apical one third of the root and three separate foramina.
It is essential to find all of the root canals in an endodontic case in order to ensure long-term treatment success (1). It is imperative that the clinician be cognizant of possible morphological variations of teeth in order to treat all of the root canals that may be present. A number of reports (2-6) have addressed the morphological variations of the root canal system of the palatal root of the maxillary molar. Thews et al. (2) have reported two cases of unusual variations of the root canal system in the palatal root of maxillary first molars. The first case had two distinct palatal roots with corresponding root canals; the second case had a single palatal root with two distinct root canal orifices and canals that appeared to terminate in a common apical foramen. Harris (2), Benenati (3), and Bond et al. (4) have reported cases of maxillary molars with a single palatal root containing two separate orifices and root canals. Stone and Stoner (5) and Cecic et al. (6) have reported cases in which the palatal root contained one orifice, a bifurcated canal, and two foramina. The following clinical case is a report of a variation of the palatal root canal anatomy of a maxillary molar thus far not reported.
i
I i
FiG 1. Radiograph of tooth 14 with indistinct image of the palatal root.
CASE R E P O R T FIG 2. Radiograph of initial length files in place. File in palatal canal is
A 22-yr-old white male was referred to the endodontic service for completion of root canal therapy of the maxillary left first molar. Six weeks previously, after a carious exposure of this tooth, the pulp was partially extirpated, and a formocresol cotton pellet and temporary seal placed. The patient's medical history was noncontributory. Clinical examination revealed the tooth to be asymptomatic. The radiographic examination disclosed an indistinct image of the palatal root attributed to the superimposition of the zygomatic arch (Fig. 1). Access into the maxillary molar
off-centered.
was prepared; only three canals were located. Length determination was established (Fig. 2); the canals were instrumented and filled with laterally condensed gutta-percha and Roth 801 Elite grade sealer (Roth Drug Co., Chicago, IL). The postoperative radiograph (Fig. 3) revealed the palatal root canal to have a trifurcation at the apical one third. The entire 298
Vol. 17, No. 6, June 1991
FIG 3. Radiograph o f poorly obturated palatal root canal system revealing trifurcation at the apical one third.
Palatal Root with Three Canals
299
F~G 5. Postoperative radiograph showing the final root canal filling.
DISCUSSION In retrospect, the indistinct image of the palatal root on the preoperative radiograph should have cautioned the author to the possibility of a second canal. In addition, the initial length determination radiograph revealed the file in the palatal root to be off-centered (Fig. 2). Slowey (8) has stressed the need for further exploration when such findings occur. Location of a third canal was found with the aid of the first postoperative radiograph which serendipitously revealed the trifurcated root canal system. The assumption that this tooth had only one palatal canal stresses the importance that morphological variations are usually unexpected and when they occur we must be quick to reevaluate our procedure and deal with the anomaly as it presents.
FiG 4. Radiograph of length files at time of retreatment, with three files in the palatal root.
root canal filling was removed immediately and the patiem rescheduled for further instrumentation. At the second appointment, with the aid of the postoperative radiograph indicating a trifurcation of the palatal root canal system, the three separate canals could be distinguished. Figure 4 shows the five instruments in the root canals. After canal preparation, the tooth was dried with paper points and a cotton pellet was sealed in the pulp chamber with IRM (L. D. Caulk Co., Division of Dentsply, Milford, DE). At the next appointment, three #30 gutta-percha points were fitted and placed into the palatal canals with Roth 801 Elite grade sealer. Lateral condensation with accessory points was used to obturate the palatal canals. The mesiobuccal and distobuccal canals were obturated in a similar manner. A final radiograph was taken (Fig. 5).
The views expressed in this article are those of the author and do not reflect the official policy or position of the Department of Defense or the United States government. Dr. Wong is chief and mentor of endodontics, Advanced Educational Program in general dentistry (2 yr), Ft. Hood, TX. Address requests for reprints to COL Marston Wong, USA Dentac, Fort Hood, TX 76544-5063.
References 1. Fahid A, Taintor JF. Maxillary second molar with three buccal roots. J Endodon 1988;14:181-3. 2. Thews ME, Kemp WB, Jones CR. Aberrations in palatal root and root canal morphology of two maxillary first molars. J Endodon 1979;5:94-6. 3. Harris WE. Unusual root canal anatomy in a maxillary molar. J Endodon 1980;6:573-5. 4. Benenati FW. Maxillary second molar with two palatal canals and a palatogingival groove. J Endodon 1985;11:308-10. 5. Bond JL, Hartwell G, Portell FR. Maxillary first molar with six canals. J Endodon 1988;14:256-60. 6. Stone LH, Stoner WF. Maxillary molars demonstrating more than one palatal root canal. Oral Surg 1981 ;51:649-52. 7. Cecic P, Hartwell G, Bellizzi R. The multiple root canal system in the maxillary first molar: a case report. J Endodon 1982;8:113-5. 8. Slowey RR. Root canal anatomy--road map to successful endodontics. Dent Clin North Am 1979;23:555-73.
