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Alec  Such
Posted June 14, 2018 by Alec Such
This started out to be a normal case. Upon access there was a lot of bleeding on the pulpal floor Dental Chair. I used a slow round to smooth out the pulpal floor under the microscope. I was able to see a total of 5 canals and treat them.

To investigate properly the possibility of additional canals, the dentist should:

Take additional off-angle radiographs or CBCT;
Ensure adequate “straight-line” access to improve visibility and make sure the canal is centered in the root;
Examine the pulpal floor for “lines” to areas where additional canals may be located;
Remove a small amount of tooth structure or the dentinal shelf, which often may occlude a canal orifice.
The frequency of a maxillary first molar with two palatal canals is very low, about 1%. I may not ever see another one in my lifetime.

Figure 1: Pre-op image showing the palatal root looking calcified.
Figure 2: Post-op image showing the canals: MB1 (mesial buccal), MB2 (second mesial buccal), DB (disto buccal), P1 (first palatal canal), P2 (second palatal canal).

Figure 3: Post-op inverted view showing all 5 canals dental scaling machine. Figure 4: Post-op normal view showing all 5 canals.
This case contributes to our understanding of the complexity of the root canal morphology found in maxillary first molars implant machine. Although such cases occur infrequently, dentists should be aware of them when considering endodontic treatment of a maxillary first molar.
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