Root Canal Treatment of Mandibular Molar With Accessory Root Canal: A Case Report

Abstract

Root canal treatment comprises of cleaning and shaping, disinfecting, and root canal obturation. The success of treatment depends on the knowledge of the operator regarding root canal morphology. The mandibular first molars usually have two roots with three canals: distal, mesio-buccal and mesio-lingual. There is a possibility of an additional distolingual root namely radix entomolaris. A 21-year-old male patient was referred to Universitas Gadjah Mada Dental Hospital for root canal treatment. After subjective and objective examination, diagnosis of tooth 36 was pulp necrosis. Dental history of patient revealed caries occurred in left mandibular molar along with spontaneous pain that lasted for hours. The referring dentist had done pulp devitalization and prescribed oral analgesics. Shaping and cleaning were performed on mesio-buccal, mesio-lingual and distal root canal followed by intracanal dressing on first visit. Three days later the patient came with complaint of spontaneous pain. After careful observation, a distolingual root was found, which previously had not been prepared. Root canal preparation was carried out on the distolingual root followed by intracanal dressing. On third visit, the tooth was asymptomatic and root canals were obturated. On fourth visit, the tooth was prepared for onlay restoration and impression was taken. Composite onlay was cemented on the fifth visit. A week later the patient came for recall and no complaints were noted. Conclusion: root canal treatment on mandibular first molars must consider the anatomic variations, such as radix entomolaris. Using proper diagnostic aids and instruments would help identify acessory root canal. A thorough root canal preparation influence the success of root canal treatment.