Root canal treatment of maxillary second molar with three mesial buccal root canals: a case report and literature review

To explore the key points of clinical diagnosis and treatment of three mesiobuccal root canals.

In the procedure of endodontic therapy for the upper left second molar with pulpitis, through root canal exploration under a dental microscope and cone beam CT (CBCT)-assisted imaging examination, it was confirmed that the left upper second molar contained 3 roots and 5 root canals, among which the third root canal existed in the mesiobuccal root. Combined with perfect root canal preparation, cleaning, disinfection, filling and minimally invasive inlay repair, the clinical symptoms were eliminated. The patients were followed up and the related literatures were reviewed.

One- and two-year follow-ups showed that the tooth had no discomfort and could be used normally. X-ray revealed that the filling was complete, and the periapical tissue was normal. The results of the literature review showed that the incidence of three mesiobuccal root canals in maxillary second molars was 0.11%-4.2%. It is difficult to find additional root canals only by X-ray imaging. Dentists should further determine the number and anatomical shape of root canals by CBCT and operating microscopy. When there are three mesiobuccal root canals in maxillary molars, dentists should avoid overpreparation. Healthy tooth tissue is the key to good prognosis.

During root canal therapy, clinicians should consider the anatomical variation of the root canal, should always be alert to the existence of an extra root canal, and should use CBCT, operating microscopy, ultrasound and various auxiliary instruments to locate and treat the variant root canal.