Endodontic management of maxillary permanent first molar with 6 root canals: 3 case reports Denzil Valerian Albuquerque, BDS, a Jojo Kottoor, BDS, a Sonal Dham, BDS, a Natanasabapathy Velmurugan, MDS, b Mohan Abarajithan, MDS, c and Rajmohan Sudha, MDS, d Tamil Nadu, India MEENAKSHI AMMAL DENTAL COLLEGE AND HOSPITAL This article discusses the successful endodontic management of 3 permanent maxillary first molars presenting with the anatomical variation of 3 roots and 6 root canals. A literature review pertaining to the variable root canal morphology of the permanent maxillary first molar is also presented. Modifications in the root canal access preparation and methods for examination of the pulpal floor with the aid of magnification for identification of additional canals are emphasized. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2010;110:e79-e83) The goal of root canal treatment is to clean and shape the root canal system and obturate it in all of its dimensions. 1 Aberrant root or root canal morphology when present should be adequately detected and treated. Failure to recognize any unusual canal config- uration would eventually lead to unsuccessful treatment outcome. 2 Thus, a thorough knowledge of the root and root canal morphology along with their various ana- tomical variations is essential so as to reach this goal. The root canal anatomy of maxillary first molars has been described as 3 roots with 3 canals and the common- est variation is the presence of a second mesiobuccal canal (MB 2 ). The incidence of MB 2 has been reported to be between 56.8% and 96.1%. 3-5 Apart from these usual presentations, a wide variation of root canal configurations of the maxillary first molars have been documented in numerous case reports. These range from a single root canal in a single root, 6 C-shaped canals, 7 2 root canals, 2 5 root canals, 8 and 6 root canals. 9 Recently, Kottoor et al. 10 reported the endodontic management of a maxillary first molar with 7 root canals. Cleghorn et al. 3 reported that the incidence of a second root canal in the distobuccal root is 1.7% and less than 1.0% in the palatal root. This article discusses the successful nonsurgical endodontic manage- ment of 3 permanent maxillary first molars presenting with the anatomical variation of 3 roots and 6 canals. CASE REPORTS These are the case reports of 3 patients treated in the Depart- ment of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College, Chennai, India. A thorough history was recorded, and the cases were examined both clinically and ra- diographically. The medical history of all patients was noncon- tributory. Vitality testing of the involved tooth was carried out with heated gutta-percha (Dentsply Maillefer, Ballaigues, Swit- zerland), cold test (RC Ice, Prime Dental Products Pvt. Ltd., Mumbai, India), and electronic pulp stimulation (Parkel Elec- tronics Division, Farmingdale, NY). Local anesthesia was ob- tained with 1.8 mL (30 mg) of 2% lignocaine containing 1:200,000 epinephrine (Xylocaine, AstraZeneca Pharma Ind Ltd, Bangalore, India). The entire procedure in each case was carried out using rubber dam isolation under a surgical operating microscope (Seiler Revelation Microscope, St. Louis, MO). The working length was determined with the apex locator (Root ZX; Morita, Tokyo, Japan) and confirmed radiographically. Cleaning and shaping were performed using a crown-down technique with ProTaper series Ni-Ti rotary instruments (Dentsply Maillefer, Ballaigues, Switzerland) with irrigation using normal saline, 3% sodium hypochlorite, and 17% EDTA (Prime Dental Product Pvt. Ltd.). All canals were dried with absorbent points (Dentsply Tulsa, Tulsa, OK) and obturated using cold, laterally compacted gutta-percha and AH Plus sealer (Dentsply Tulsa). Each tooth was then restored with a posterior composite resin core (P60; 3M Dental Products, St Paul, MN). The patients were asymptomatic in the subsequent follow-up period. Case 1 A 55-year-old male patient presented with the chief com- plaint of “toothache in his left upper back tooth.” The pain was continuous and had intensified for 3 days, with a history of intermittent pain over the preceding 3 months. Clinical a Postgraduate Student, Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Tamil Nadu, India. b Professor and Head of Department, Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Tamil Nadu, India. c Senior Lecturer, Department of Conservative Dentistry and End- odontics, Meenakshi Ammal Dental College and Hospital, Tamil Nadu, India. d Reader, Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Tamil Nadu, India. Received for publication Mar 28, 2010; accepted for publication Apr 8, 2010. 1079-2104/$ - see front matter © 2010 Mosby, Inc. All rights reserved. doi:10.1016/j.tripleo.2010.04.017 e79