Maxillary First Molar With Vertucci Type ⅴ Distobuccal Canals

This case report describes a rare Type V root canal configuration in the distobuccal root of a maxillary first molar, addressing the diagnostic and technical challenges posed by complex root canal anatomy in maxillary molars. While mesiobuccal root variations are common, this study documents an uncommon distobuccal root canal variation rarely reported in existing literature. A patient presented with a 2-week history of a buccal sinus tract adjacent to tooth #3. Clinical examination revealed a defective mesio-occlusal restoration, negative response to cold testing, mild percussion sensitivity. Radiographic evaluation demonstrated periapical radiolucency and furcation involvement. CBCT imaging revealed a distobuccal root with apical bifurcation, consistent with Vertucci Type V canal configuration. The diagnosis was chronic apical periodontitis with complex root canal morphology. Microscopic endodontic treatment was performed, with five canals (MB, MB2, DB, DB2, P) obturated. Two - year - five - month follow - up showed asymptomatic status and radiographic resolution of lesions, indicating successful healing. When interpreting periapical radiographs, abrupt narrowing or disappearance of a single root canal should raise suspicion of canal bifurcation. When diagnosis remains uncertain, cone-beam computed tomography (CBCT) imaging can clearly delineate root canal variations. For Vertucci Type V canal configurations, clinicians must strive to balance minimally invasive approaches with thorough debridement. Maintaining heightened awareness of anatomical variations and vigilance for uncommon canal morphologies is crucial. The utilization of a DOM and CBCT in endodontically challenging cases can facilitate a better understanding of the complex root canal anatomy.