Endodontic Treatment of the first Maxillary Molar with 7 Root Canals: Case Report

Abstract

The anatomical complexity of the root canal system is an ongoing challenge for the endodontist. The morphology of the permanent maxillary first molar contains numerous variations regarding the number of roots and canals. Thus, the success of endodontic treatment is related to the domain of anatomy. The aim of this study is to present a case report on a maxillary first molar with seven root canals.A 17-year-old female patient, melanoderm, was seen at the multidisciplinary clinic for a routine examination. In the clinical examination, a extensive carie was found in element 14. Radio graphically, radiolucent area was observed circumscribing the root apexes of this dental element. The following steps were performed. Anesthesia with 2% lidocaine, access surgery, absolute isolation and irrigation with 2.5% sodium hypochlorite. With the aid of ultrasonic vibration with an E7D insert at a frequency of 30 kHz for 20 seconds, connected to a piezoelectric device, the pulp chamber floor was refined. After this procedure it was found, through the exploration of a 10 K file and magnification with operative microscope, atypical anatomy with extra canals: mesiobuccal canal 1, mesiobuccal canal 2, vestibular mesio 3, distobuccal 1, distobuccal 2, palatine 1 and palatine 2.Cervical third preparation was performed with the aid of a Logic 25/05 rotary instrument, confirmation of working length with foraminal locator, apical third preparation and intracanal medication insertion: calcium hydroxide. Soon after the consultation, a computed tomography was requested to confirm the root canals. In the second session, after removal of intracanal medication, rotary files were recapitulated, 2.5% sodium hypochlorite irrigation, final irrigation with agitated EDTA with 25 IRRS ultrasound insert and thermoplastic obturation.The dental element was restored and a new CT scan was requested for follow-up. In this context, it can be concluded that the dental surgeon must be aware of the anatomical diversity, thus avoiding failures. The patient remains asymptomatic and dental element performing its functions.