Management of a rare bilateral maxillary first molar with six canals using a cone-beam computed tomography: Report of two cases

Management of a rare bilateral maxillary first molar with six canals using a cone-beam computed tomography: Report of two cases

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The complex morphology of pulp cavities, particularly in multi-rooted teeth, poses a persistent challenge for the success of endodontic therapy.It is vital to grasp the typical anatomical traits, 3 piece horse wall art as failure to address them may lead to endodontic treatment failure.In this case report, the clinical management of a maxillary first molar with an exceptionally rare bilateral presentation of three roots and six root canals is described, which was endodontically managed by taking advantage of cone-beam computed tomography (CBCT), dental operating microscope, and advanced endodontic tools.A 32-year-old male patient presented with complaints of pain and food lodgment in the upper left and right back teeth.The pain associated with the maxillary right first molar (tooth #16) was intermittent, dull aching, and throbbing, with nocturnal exacerbation, whereas the maxillary left first molar (tooth #26) showed a spontaneous lingering nature of pain.

Clinical examination revealed a previous coronal restoration on tooth #16 and mesioproximal caries on tooth #26.Pulp sensibility tests indicated no response for tooth #16 and a delayed response for tooth #26, whereas both teeth read more were tender to percussion.Radiographic assessment showed periapical changes in both teeth.Hence, the final diagnoses of pulp necrosis with symptomatic apical periodontitis for tooth #16 and symptomatic irreversible pulpitis with symptomatic apical periodontitis for tooth #26 were made.Endodontic treatment was initiated, suspecting multiple canals, which was confirmed intraoperatively using CBCT and a dental operating microscope.

Complete cleaning and shaping of all six canals were performed, followed by obturation using bioceramic sealer and bioceramic gutta-percha.Postendodontic restoration with composite resin and porcelain crown was carried out.A successful outcome was observed as the patient had relief of symptoms and periapical healing was evident at the 6-month follow-up.The importance of documenting such uncommon cases in dental literature is highlighted in this report, which will enhance understanding and help clinicians manage similar anatomical complexities.