Unveiling the Hidden: Management of a middle mesial canal in a mandibular second molar – A case report

The primary objective of root canal treatment is to obtain three-dimensional obturation of the root canal space after cleaning debris from the canal. Anatomic variations are commonly observed in endodontic practice and require careful management by the clinician. A notable example of such a variation is the occurrence of a third canal in the mesial root of the mandibular second molar. Typically, mandibular second molars had two mesial canals (mesio-buccal and mesio-lingual), but the occurrence of a middle mesial canal posed a challenge for the clinician to locate and identify. This variation could influence the efficacy of cleaning and shaping procedures, as well as the overall success of endodontic therapy. The present case described tooth #37 with a chief complaint of food lodgment, pain, and tenderness on chewing. The radiograph revealed a distoproximal radiolucency involving the pulp. The mesial root appeared wider, suggestive of some anatomic variation. The diagnosis of symptomatic irreversible pulpitis with apical periodontitis was made. The treatment plan included conventional root canal therapy followed by a coronal prosthesis. A good prognosis was expected. The additional mesial canal in the second mandibular molar is a rare anatomic configuration, which emphasized that the operator had to be thorough with the expected variations, its negotiation, and the judicious preparation of the canal based on those variations.