Endodontic management of maxillary first molar with five canals: Report of a case aided with spiral computed tomography

Introduction. Maxillary first molars have shown substantial dissimilarity regarding their number of roots, canals and morphology. Most commonly, it has three roots and four canals, two mesiobuccal, one distobuccal and one palatal canal. The incidence of second mesiobuccal canal has been reported between 18% and 96.1% while the incidence of two distobuccal canals was found in 1.64% to 9.50% of cases. Periapical (PA) radiography has been commonly used to determine root canal anatomy even though it is two-dimensional representation of a three-dimensional object. Advanced diagnostic methods as spiral computed tomography (SCT) provide three-dimensional images useful to determine complex canal morphology. Case Report. A 31-year-old male patient was referred for endodontic treatment of the maxillary right first molar. Endodontic access cavity revealed two canal openings in each of the mesiobuccal and distobuccal roots and one canal in the palatal root later confirmed using the SCT and conventional PA radiography. The canals were instrumented using crown down technique with ProTaper NiTi rotary files. Obturation was performed using single gutta-percha cone and AH Plus paste. The patient remained asymptomatic during the regular checkups. Conclusion. Knowledge, detection and management of complex canal anatomy is of the foremost importance in endodontics since missed canals are one of well recognised reasons for endodontic treatment failure.