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198 rev port estomatol med dent cir maxilofac. 2019;60(4):197-204

Tratamento endodôntico de molar superior com 7 canais radiculares
– relato de dois casos

r e s u m o

Palavras-chave: O primeiro molar superior definitivo é descrito com uma enorme variedade de configura-
Anatomia ções do sistema canalar. Neste trabalho apresentamos dois casos de molares superiores
Endodontia com uma morfologia invulgar de 7 canais radiculares. Depois de estabelecido o acesso à
Molar câmara pulpar, foram detetados dois sulcos de desenvolvimento com coloração mais es-
Morfologia cura a interligar os dois canais vestibulares principais ao palatino. Sob ampliação e ilumi-
Tratamento endodôntico nação do microscópio cirúrgico, estes dois sulcos foram explorados com pontas ultrassó-
nicas, o que permitiu identificar vários orifícios de entrada canalar adicionais em ambas
as raízes vestibulares complementadas por um único canal palatino num dos casos, e dois
no outro. Debatemos também as questões de desenvolvimento embrionário relacionadas
com as diferentes configurações anatómicas e as melhores abordagens clínicas para estes
casos. Reconhecer as complexidades da anatomia interna canalar pode contribuir para
maximizar a taxa de sucesso do tratamento endodôntico. (Rev Port Estomatol Med Dent Cir
Maxilofac. 2019;60(4):197-204)
© 2019 Sociedade Portuguesa de Estomatologia e Medicina Dentária.
Published by SPEMD. This is an open access article under the CC BY-NC-ND license
(http://creativecommons.org/licenses/by-nc-nd/4.0/).

acute pain in the maxillary left side, which tended to increase
Introduction
with cold temperature. The reported medical history was
The morphology of the maxillary first molar has been exten- non-contributory. On clinical examination, a large carious le-
sively studied over the years. The most common pulp cham- sion was observed on the mesial and occlusal aspects of the
ber floor configuration for the maxillary first molar is the maxillary left first molar (tooth 26); however, no periodontal
1
presence of four root canal orifices, but configurations rang- pockets were noted, the tooth mobility was within physiolog-
ing from one to eight root canals have also been reported. 1-3 ical limits and none of the teeth 25, 26 or 27 were tender to
4
Root fusion with main root canals merging or even C-shaped percussion or palpation. The response to the cold-sensitive
(5)
anatomies have also been documented. test (Endo cold spray, Henry Schein, Germany) was an intense
The scientific evidence shows that the clinical efficacy of pain on tooth 26 and normal response on tooth 27. The preop-
root canal therapy is not only associated with correct coronary erative radiographic examination confirmed the involvement
rehabilitation but is also clearly linked with complete instru- of tooth 26 (Figure 1). Considering the clinical and radiograph-
mentation, disinfection and obturation of the root canal sys- ic findings, tooth 26 was diagnosed with symptomatic irre-
tem. The preoperative periapical status has also been pointed versible pulpitis with normal periapical tissues. Root canal
6
out as a potential prognostic factor for the success of both pri- treatment was scheduled after being accepted by the patient.
mary and secondary non-surgical root canal treatment. More- Following a buccal infiltration anesthesia performed using
7
over, even under controlled conditions, persistent periapical 1.8 mL of 4% articaine with 1:200.000 epinephrine (Artinibsa,
inflammation may develop, or persist, as a tissue response to Inibsa, Spain), proper rubber dam (R&S Dental Dam, CFPM,
8
the endodontic treatment. The anatomic variation of the max- France) isolation was obtained. The carious lesion was exca-
illary first molar is wide, and, although understanding the anat- vated, and the endodontic access prepared. A careful inspec-
omy of the tooth under treatment may be a challenge, it is un- tion of the pulp chamber floor was possible after the removal
arguably important. Several authors have stated that previous of loose pulp stones with the aid of a #2 ProUltra ultrasonic tip
root canal treatment failures might be associated with endodon- (ProUltra, Dentsply Maillefer, USA). Three main root canal ori-
tic therapies that leave missed and untreated root canals. 9,10 fices were identified: mesiobuccal (MB1), distobuccal (DB1) and
The objective of this paper is to present two cases of an palatal (P). Upon a more detailed observation of the chamber
uncommon configuration of the maxillary first molar present- floor using a surgical microscope (Opmi Pico, Carl Zeiss Surgi-
ing three roots and seven root canals. cal, Germany), two dark developmental grooves were observed
connecting both the main buccal canals to the palatal one.
These developmental grooves were explored with #2 ProUltra
Case reports ultrasonic tip troughing, and four extra canals were detected
(MB2, MB3, DB2 and DB3). A total of seven root canals were
Case # 1 identified (Figures 2, 3, 4).
A 52-year-old Caucasian female was referred to an emergency All canals were negotiated using an ISO size.08 stain-
appointment with a chief complaint of spontaneous and less-steel hand file, and the working length was determined