Radix Entomolaris with Middle Mesial Canal: A Rare Case

Ab s t r Ac t 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.