Alammari Ammar, Alghamdi Faisal, Albeladi Rayed, Abed Hassan, Yagmoor Mohammed
Department of Endodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU.
Department of Oral Biology, Faculty of Dentistry, King Abdulaziz University, Jeddah, SAU.
Cureus. 2025 May 15;17(5):e84205. doi: 10.7759/cureus.84205. eCollection 2025 May.
This case report presents a less common anatomical variation in a maxillary second molar (MSM) characterized by four roots - two buccal and two palatal - and four distinct canals. The report emphasizes the significance of advanced diagnostic imaging and careful clinical evaluation in identifying and managing less common anatomical variations in maxillary second molars. Specifically, it presents the endodontic management of an MSM with two buccal and two separate palatal roots - detected using a cone beam computed tomography (CBCT) - underscoring the importance of comprehensive canal mapping and precise diagnosis in achieving treatment success. A 40-year-old male patient presented with intense pain in the upper right second molar, as reported by his general dentist. Clinical examination showed moderate pain on percussion and palpation. The radiological examination by CBCT scan revealed four separate roots and canals (two buccal and two palatal), with three canals filled with calcium hydroxide (Ca(OH)₂). Non-surgical root canal treatment was approached for the endodontic treatment. The nine-month follow-up showed resolution of all symptoms without pain on percussion and palpation. We conclude that a comprehensive understanding of the complex root canal morphology of MSMs is crucial for achieving successful endodontic outcomes. While common variations include three roots and three canals, less frequent configurations, such as a single root or four distinct roots with separate canals, emphasize the importance of comprehensive assessment. The prognosis currently demonstrates a higher success rate due to advancements in endodontic instruments and materials. Several factors play a role in success rate, such as the operator's experience, the number and location of canals, the treatment duration, and the utilization of tools like a microscope and CBCT, which can enhance the chances of achieving higher success rates in managing unusual variations of MSM.
本病例报告展示了上颌第二磨牙（MSM）一种较罕见的解剖变异，其特征为有四个牙根——两个颊侧牙根和两个腭侧牙根，以及四条不同的根管。该报告强调了先进的诊断成像和仔细的临床评估在识别和处理上颌第二磨牙少见解剖变异方面的重要性。具体而言，报告呈现了一例使用锥形束计算机断层扫描（CBCT）检测出有两个颊侧牙根和两个独立腭侧牙根的上颌第二磨牙的牙髓治疗情况，突出了全面根管测绘和精确诊断对治疗成功的重要性。一名40岁男性患者，据其普通牙医报告，右上颌第二磨牙剧痛。临床检查显示叩诊和触诊时有中度疼痛。CBCT扫描的影像学检查显示有四个独立的牙根和根管（两个颊侧和两个腭侧），其中三条根管已用氢氧化钙（Ca(OH)₂）充填。牙髓治疗采用非手术根管治疗法。九个月的随访显示所有症状均已消除，叩诊和触诊时均无疼痛。我们得出结论，全面了解上颌第二磨牙复杂的根管形态对于牙髓治疗取得成功至关重要。虽然常见变异包括三个牙根和三条根管，但较罕见的形态，如单一根管或四个带有独立根管的不同牙根，强调了全面评估的重要性。由于牙髓治疗器械和材料的进步，目前预后显示成功率较高。成功率受几个因素影响，如操作者的经验、根管的数量和位置、治疗持续时间以及显微镜和CBCT等工具的使用，这些可增加成功处理上颌第二磨牙异常变异的几率。
