Reatreatment Of Maxillary First Molar With Palatal Canal Variation

Introduction: A rare case of a maxillary first molar with five root canals, including a double palatal root canal exhibiting Type V (1-2) configuration, is presented. The use of a dental operating microscope(DOM) and Cone-beam computed tomography(CBCT) aided in identifying root canal complexities, resulting in effective retreatment. Case description: A 52-year-old Swedish male presented with discomfort in his right upper posterior tooth for three months and was diagnosed with symptomatic chronic periapical periodontitis of tooth 16. Radiographic examination of tooth 16 revealed incomplete radiopaque fillings in multiple root canals, calcifications in various sections, missed second mesiobuccal canal (MB2), calcified canals, bifurcated and curved palatal canal (Vertucci type V), and periapical translucency. Identification and successful negotiation of missed canal using CBCT and DOM, leading to treatment of all five canals. Discussion: The treatment challenge in this case stemmed from the variation in the palatal root canal of the maxillary first molar, which curved and split into two canals in the apical third (type 1-2), making it easily overlooked. The use of CBCT and DOM, along with strategic enlargement and refinement of the access cavity, exploration of grooves beyond the main canals, and careful removal of superficial calcifications with ultrasonic instruments, enhances the detection rate of missed canals. Conclusion/clinical significance: The presence of variations in the root canal morphology in the maxillary first molar merits significant attention for dentists.