IP Indian Journal of Conservative and Endodontics 2020;5(3):147–149 Content available at: https://www.ipinnovative.com/open-access-journals IP Indian Journal of Conservative and Endodontics Journal homepage: www.ipinnovative.com Case Report Endodontic management of radix entomolaris with middle mesial canal –A case report Ipsita Pathak 1, *, Nazia Ali 1 , Praveen Singh Samant 1 , Raju Chauhan 1 1 Dept. of Conservative Dentistry & Endodontics, Saraswati Dental College, Lucknow, Uttar Pradesh, India ARTICLE INFO Article history: Received 25-08-2020 Accepted 03-09-2020 Available online 07-09-2020 Keywords: Anatomical variation Radix entomolaris Permanent mandibular first molar Middle mesial canal Root canal therapy ABSTRACT Mandibular molars exhibit variations in its internal anatomy; one among those is the presence of an extra canal in the mesial root called as middle mesial (MM) canal. Variation in the number of roots and canal morphology is not scarce. Presence of an additional root when found disto-lingually called as Radix entomolaris. This case report describes the treatment of chronic apical periodontitis with unusual morphology of mandibular first molars in 34 years old male patient. The treatment strategy included root canal therapy without the aid of any magnification devices. © 2020 Published by Innovative Publication. This is an open access article under the CC BY-NC license (https://creativecommons.org/licenses/by-nc/4.0/) 1. Introduction The primary aim of endodontic therapy is total debridement of pulp space and obturates the root canal system to prevent re-infection. The understanding of the variations of unusual root canal morphology can thus contribute to the successful outcome of the root canal treatment. 1,2 Different types of variations are found in mandibular firs molar like numerous canals in both mesial and distal root, extra root as in radix entomolaris, radix paramolaris, C-shaped canal anatomy, etc. 3–7 The incidence of middle mesial canals ranges between 2.07% - 13.3%, and incidence of radix entomolaris in Indian population are <5%. 7 It is of foremost importance to locate all the root canals and scrupulous mechanical and chemical cleansing of the entire pulp space, followed by three-dimensional obturation with an inert filling material. 8 2. Case Report A 34 year old male patient came to Department of Conservative Dentistry & Endodontics, Saraswati Dental * Corresponding author. E-mail address: dripsitapathak@gmail.com (I. Pathak). College, with non-contributory medical history reported with a chief complaint of intermittent pain in the lower right back teeth region since 1 month. The pain used to intensify by thermal and physical stimuli. On clinical examination, a deep proximal caries was seen on the first molar, and the tooth was tender on percussion. The electric pulp testing revealed a delayed response. On radiographic examination, the carious lesion involved the pulp with no apical changes. The case was diagnosed as chronic apical periodontitis in relation to right mandibular first molar (#46) (Figure 1). Based on clinical and radiographic interpretation, it was decided to perform endodontic therapy. The tooth was anaesthetized followed by rubber dam isolation. The pulp chamber was opened using a large round bur and the access cavity was refined using EZ bur (Dentsply). Exploring the orifices was done with a sharp endodontic explorer a catch was found between the main mesial canals. A small instrument (#6 and 8 K File, Dentsply) was inserted into the canal using watch winding motion and slowly advanced into the root canal. Pulp extirpation was done, after checking the patency of all the five canals, with # 10K file. Totally five https://doi.org/10.18231/j.ijce.2020.035 2581-9534/© 2020 Innovative Publication, All rights reserved. 147