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VOLUME 4 , ISSUE 2 ( July-December, 2019 ) > List of Articles


Radix Entomolaris with Middle Mesial Canal: A Rare Case

A Devadathan, Minimol K Johny, Manuja Nair

Keywords : Mandibular molar, Middle mesial canal, Radix entomolaris

Citation Information : Devadathan A, Johny MK, Nair M. Radix Entomolaris with Middle Mesial Canal: A Rare Case. Cons Dent Endod J 2019; 4 (2):44-48.

DOI: 10.5005/jp-journals-10048-0050

License: CC BY-NC 4.0

Published Online: 18-07-2020

Copyright Statement:  Copyright © 2019; The Author(s).


Background: Attention to detail with an analytically trained and developed mind is undoubtedly a dental practitioner's most important asset to identify rare and only heard of conditions in patients. Being a field of explosive development due to new technologies, endodontics aids to provide an accurate diagnosis of the complex anatomical variations and conditions of the teeth. Radix entomolaris (RE) is the presence of an additional distolingual (DL) root in the mandibular first molars and its prevalence in the South Indian population is 13.3%. The presence of RE with middle mesial canal (MMC) in the mandibular first molar is a rare experience of the combined occurrence of two uncommon conditions requiring appropriate diagnosis and cautious management. Its management relies on the proper diagnosis and exploration of all the canals, thorough chemomechanical preparation, followed by three-dimensional (3D) obturation without hampering the original root canal anatomy. The appropriate utilization of the advanced aids of magnification and technology, such as the microscopes, loupes, and conebeam computed tomography (CBCT), coupled with the use of thermomechanically treated flexible NiTi files enhances the success in the endodontics while dealing with such rare entities. This article presents a case report of an RE with MMC which is definitely rare in occurrence and requires cautious management. Case description: A 20-year-old female patient was diagnosed with symptomatic irreversible pulpitis with apical periodontitis on the mandibular first molar. It was identified as an RE with MMC on radiographic examination using the Clark's Tubeshift technique. After anesthetizing the tooth using inferior alveolar nerve block, rubber dam isolation was done. The access cavity was prepared and modified distolingually and the canal orifices were located. The MMC orifice was troughed along the groove joining mesiobuccal (MB) and mesiolingual (ML) canals using long shank burs and a sharp DG-16 explorer. The cleaning and shaping procedures were performed carefully to all six canals using NiTi files followed by the 3D obturation. Conclusion: This case report is a precise description of the effective management of RE with MMC which is a rare entity in our ethnic group. This case was diagnosed using the Clark's Tubeshift technique and managed using magnifying loupe and thermomechanically treated flexible NiTi files. The advanced aids in 3D imaging such as the CBCT, spiral computed tomography (CT), and the magnifying aids such as microscopes coupled with thermoplasticized obturation can accentuate the success rate of such complex morphologies.

  1. Carabelli G. Systematisches Handbuch der Zahnheilkunde. 2nd ed., Vol. 1844, Vienna: Braumuller und Seidel; 1844, p. 114.
  2. Chandra SS, Chandra S, Shankar P, et al. Prevalance of radix entomolaris in mandibular permanent first molars: a study in South Indian population. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2011;112(3):e77–e82. DOI: 10.1016/j.tripleo.2011.02.016.
  3. De Moor RJG, Deroose CAJG, Calberson FLG. The radix entomolaris in mandibular first molars: an endodontic challenge. Int Endod J 2004;37(11):789–799. DOI: 10.1111/j.1365-2591.2004.00870.x.
  4. Tratman EK. Three-rooted lower molars in man and their racial distribution. Br Dent J 1938;64:264–274.
  5. Calberson FL, Moor RJDee, Deroose CA. The radix entomolaris and paramolaris: clinical approach in endodontics. J Endod 2007;33(1): 58–63. DOI: 10.1016/j.joen.2006.05.007.
  6. Teixeira FB, Sano CL, Gomes BP, et al. A preliminary in vitro study of the incidence and position of the root canal isthmus in maxillary and mandibular first molars. Int Endod J 2003;36(4):276–280. DOI: 10.1046/j.1365-2591.2003.00638.x.
  7. Baruwa AO, Martins JNR, Meirinhos J, et al. The influence of missed canals on the prevalence of periapical lesions in endodontically treated teeth: a cross-sectional study. J Endod 2019; 1–6.
  8. The Root Canal Anatomy in Permanent Dentition Versiani MA, Basrani Bettina, Sousa-Neto MD 1st ed., Springer International Publishing; 2019.
  9. De Toubes KM, Côrtes MI, Valadares MA, et al. Comparative analysis of accessory mesial canal identification in mandibular first molars by using four different diagnostic methods. J Endod 2012;38(4):436–441. DOI: 10.1016/j.joen.2011.12.035.
  10. Yew SC, Chan K. A retrospective study of endodontically treated mandibular first molars in a Chinese population. J Endod 1993;19(9):471–473. DOI: 10.1016/S0099-2399(06)80536-4.
  11. Carlsen O, Alexandersen V. Radix entomolaris: identification morphology. J Dent Res 1990;98(5):363–373. DOI: 10.1111/j.1600-0722.1990.tb00986.x.
  12. Stroner WF. Mandibular first molar with three distal canals. Oral Surg 1984;57(5):554–557. DOI: 10.1016/0030-4220(84)90316-5.
  13. Ahmed HA, Abu-Bakr NH, Yahia NA, et al. Root and canal morphology of permanent mandibular molars in Sudanese population. Int Endod J 2007;40(10):766–771. DOI: 10.1111/j.1365-2591.2007.01283.x.
  14. Pomeranz HH, Eidelman DL, Goldberg MG. Treatment considerations of middle mesial canal of mandibualr first and second molars. J Endod 1981;7(12):565–568. DOI: 10.1016/S0099-2399(81)80216-6.
  15. Singh S, Mirdha N, Arora R, et al. A rare case report series of radix entomolaris with middle mesial canal in permanent mandibular first molar. International Journal of Current Advanced Research 2018;07(1):9411–9414.
  16. Navarro LF, Luzi A, Garcia AA, et al. Third canal in the mesial root of permanent mandibular first molars: review of the literature and presentation of 3 clinical reports and 2 in vitro studies. Med Oral Patol Oral Cir Bucal 2007;12(8):E605–E609.
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