A Case of Radix Entomolaris with Mid- Mesial Canal in A Mandibular Molar: Diagnostic and Treatment Considerations

The prerequisite of any endodontic therapy is to have familiarity with the root canal anatomy of the tooth. The pulpal cavity is the most complex structure of the tooth. Management relies on the proper diagnosis and exploration of all the canals, thorough chemo-mechanical preparation, followed by three-dimensional (3D) obturation without hampering the original root canal anatomy. A 23-year-old female patient presented with severe pain in the mandibular first molar region. Radiographic examination using SLOB rule, revealed the presence of a radix entomolaris (RE) with a mid-mesial canal (MMC). Following local anaesthesia via an inferior alveolar nerve block, rubber dam isolation was applied. An access cavity was prepared, and the canal orifices were located. Using a microscope, the MMC orifice was carefully exposed by troughing along the groove between the mesiobuccal (MB) and mesiolingual (ML) canals with long-shank burs and a DG-16 explorer. All five canals were meticulously cleaned and shaped with NiTi files, followed by 3D obturation. This case report highlights the importance of careful diagnostic evaluation and thorough knowledge of root canal anatomy variations, such as radix entomolaris (RE) and mid-mesial canal (MMC) in mandibular molars. The successful management of this case was facilitated using imaging techniques, magnification, and precise instrumentation, underscoring the need for a meticulous approach in similar complex cases. Clinicians should remain vigilant for anatomical variations to ensure comprehensive cleaning, shaping, and obturation, improving the prognosis for endodontic treatments. Key Words - Mandibular Molar, Middle-Mesial Canal (Mmc), Operating Microscope, Radix Entomolaris (Re).