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rev port estomatol med dent cir maxilofac . 2024;65(2):76-84 83

erably more challenging with only conventional periapical
radiographs.
While recognizing the additional root’s presence is indeed
pivotal, the subsequent location and effective cleaning of its
canal can be a formidable challenge. Hence, the design of an
appropriate access cavity holds paramount importance, as it
not only guarantees superior visualization of the entire pulp
chamber floor but also establishes a direct, unobstructed
pathway to the canal orifices. 9,19 The orifices of the addition-
al root canals have been described as typically located in the
lingual position, either mesially or distally from the distal
20
root canal. This distinct positioning implies that the con-
ventional access cavity preparation may not adequately ex-
pose these orifices, often requiring a larger access cavity. 9,10
When locating the canal’s orifice becomes challenging, a me-
ticulous examination of the pulp chamber floor and walls,
2
particularly in the distolingual region, becomes imperative.
In the presented cases, careful evaluation of the pulpal floor
by tracing the dark embryologic line with an endodontic ex-
plorer (DG16) was crucial for locating the canal. This approach
helped unveil the overlaying remnants of the pulp roof that
obscured the entrance to the root canal. The incorporation of
a dental microscope proved to be immensely advantageous
in locating the canals more precisely. These optical tools sig-
nificantly enhance the accuracy of the examination, facilitat-
ing a more thorough and effective exploration of the intricate
dental anatomy. 21
Additionally, the canals within this extra root have been
described as having smaller diameters and may exhibit cur-
Figure 19. The 6-month follow-up radiograph showed
no signs of apical pathology. vatures in various portions, including the coronal, middle, or
apical thirds, which increases the risk of encountering shap-
ing errors during the endodontic procedure. These errors
can significantly influence the prognosis of endodontic treat- could manifest as root canal straightening, ledge creation,
ment if the extra root canal is missed or if the canals are not root canal transportation, or even inadvertent separation of
adequately debrided. 1,3,13 The successful treatment outcomes endodontic files. 9,10 Given these challenges, a cautious ap-
in all three cases relied on crucial factors, including precise proach when preparing the canal is recommended by ensur-
identification of the extra root, accurate diagnosis, and effective ing a smooth glide path with a small K file up to size 15 be-
management of these anatomical variations. fore using rotary files, as this initial preparation serves to
Detecting these additional roots before initiating treat- reduce the torsional stress placed on the rotary files and
ment is essential to ensure accurate diagnosis and formulate helps ensure a more controlled and safe procedure. 2,9,22 Also,
appropriate treatment plans. However, it requires a meticulous when shaping the canals, a conservative approach using files
examination of various crown features that may serve as in- with less taper can help mitigate the risk of over-preparation
6
dicators. One such key feature is the presence of an extra cusp, and potential errors. By minimizing the extent of canal en-
often accompanied by a distinct distolingual lobe and cervical largement, clinicians can maintain the natural anatomy of
convexity, which should immediately raise suspicions of an the tooth and reduce the likelihood of complications associ-
additional root. 9,14 Furthermore, a comprehensive review of ated with excessive dentin removal. In essence, these pre-
periapical radiographs, taken at various angulations, may re- cautions and strategies are essential to navigate the com-
veal subtle yet crucial details indicating these additional plexities associated with the extra root, ensuring a safer and
roots. While it is feasible to identify an additional root using predictable result.
15
two-dimensional radiographs, previous studies have shown These cases highlight the importance of understanding the
that cone-beam computed tomography (CBCT) is a superior varying anatomical characteristics of mandibular molars and
method for assessing dental structures. 16,17 CBCT not only ex- how careful identification of additional roots, coupled with
cels at confirming the existence of anatomical variations such advanced diagnostic tools and techniques, can lead to success-
as additional root and missed canals, but it is also invaluable ful treatment outcomes.
for precisely pinpointing their location and orientation. 2,18 This
capability proves especially vital in distinguishing RE from RP.
Case #3 serves as a prime example of CBCT’s significance in Conflict of interest
making a definitive diagnosis that categorizes the additional
root in the buccal plane as an RP, a task that might be consid- The authors have no conflicts of interest to declare.