Endodontic treatment of the maxillary first molar with palatal canal variations: A case report and review of literature

Figure 1 Treatment process under the endodontic microscope and X-ray. A: A preoperative digital panoramic radiograph of the maxillary right region. Carious lesions are identified in the maxillary first and second molars; B: Intraoral photograph reveals five root canal orifices (white arrow) in the maxillary first molar, such as mesiobuccal (MB), second mesiobuccal (MB2), distobuccal (DB), mesiopalatal, and distopalatal (DP) canals; C: The X-ray confirms the working length of the MB, DB, and DP canals; D: The MB, MB2, DB, and DP canals are obturated with injectable thermoplasticized gutta-percha; E and F: The postoperative X-ray and cone-beam computed tomography image confirms that the MB, MB2, DB, and DP canals are tightly obturated.

Figure 2 X-ray and an intraoral photograph showing the treatment process of the mesiopalatal canal. A: The cone-beam computed tomography (CBCT) image reveals that the maxillary first molar contains three roots, and the mesiopalatal (MP) canal has not been filled (orange arrow); B: The CBCT image reveals an unfilled MP canal in the palatal root (orange arrow); C: The X-ray demonstrates the measurement of the working length of the MP canal; D: The axial sectional CBCT image reveals that the MP canal is tightly obturated (orange arrow); E: The X-ray reveals that five canals of the tooth are well obturated; F: The intraoral photograph reveals that the mesiobuccal (MB), MB2, distobuccal, MP, and distopalatal canals are obturated with gutta-percha.

Figure 3 The anatomical structure of the right maxillary first molar was analyzed by cone-beam computed tomography. A: The cone-beam computed tomography (CBCT) image reveals that the maxillary first molar contains three roots; B: The axial sectional CBCT image demonstrates that the distobuccal (DB) root has one canal, and the mesiobuccal (MB) and palatal roots have two separate canals; C: The sagittal sectional CBCT image reveals that the MB, MB2, and DB canals are well filled; D: The sagittal sectional CBCT image indicates that the mesiopalatal and distopalatal canals in the palatal root are obturated.

Figure 4 Final crown restoration of the right maxillary first molar. A: The X-ray at the 1-mo follow-up reveals that the five root canals of the tooth are well obturated; B: Final ceramic crown restoration is performed in the maxillary first molar; C: Radiographic image at the 9-mo follow-up; D: Clinical image at the 9-mo follow-up.