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

Abstract 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, 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 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.