Variation in root canal morphology, especially in maxillary first molar presents a constant challenge for a clinician in their detection and management. This case report describes the successful root canal treatment of a three rooted right maxillary first molar presenting with three canals each in the mesiobuccal and distobuccal roots and one canal in the palatal root. The clinical detection of this morphologic aberration was made using a dental operating microscope, and the canal configuration was established after correlating and computing the clinical, radiographic and cone-beam computed tomography (CBCT) scan findings. CBCT images confirmed the configuration of the canals in the mesiobuccal and distobuccal roots to be Al-Qudah and Awawdeh type (3-2) and type (3-2-1), respectively, whereas the palatal root had a Vertucci type I canal pattern. This report reaffirms the importance of careful examination of the floor of the pulp chamber with a dental operating microscope and the use of multiangled preoperative radiographs along with advanced diagnostic aids such as CBCT in identification and successful management of aberrant canal morphologies.

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• Endodontic Management of Maxillary First Molar with Seven Root Canals Diagnosed Using Cone-beam Computed Tomography: A Case Report
  Ravindranath Megha, Venkatachalam Prakash
  World Journal of Dentistry.2021; 12(1): 89.     CrossRef
• The MB3 canal in maxillary molars: a micro-CT study
  Ronald Ordinola-Zapata, Jorge N. R. Martins, Hugo Plascencia, Marco A. Versiani, Clovis M. Bramante
  Clinical Oral Investigations.2020; 24(11): 4109.     CrossRef
• Maxillary first molar with 7 root canals diagnosed using cone-beam computed tomography
  Evaldo Rodrigues, Antônio Henrique Braitt, Bruno Ferraz Galvão, Emmanuel João Nogueira Leal da Silva
  Restorative Dentistry & Endodontics.2017; 42(1): 60.     CrossRef
• Endodontic management of a maxillary first molar with seven root canal systems evaluated using cone-beam computed tomography scanning
  VijayReddy Venumuddala, Sridhar Moturi, SV Satish, BKalyan Chakravarthy, Sudhakar Malapati
  Journal of International Society of Preventive and Community Dentistry.2017; 7(5): 297.     CrossRef

Ambiguity in the root morphology of the mandibular second molars is quite common. The most common root canal configuration is 2 roots and 3 canals, nonetheless other possibilities may still exist. The presence of accessory roots is an interesting example of anatomic root variation. While the presence of radix entomolaris or radix paramolaris is regarded as a typical clinical finding of a three-rooted mandibular second permanent molar, the occurrence of an additional mesial root is rather uncommon and represents a possibility of deviation from the regular norms. This case report describes successful endodontic management of a three-rooted mandibular second molar presenting with an unusual accessory mesial root, which was identified with the aid of multiangled radiographs and cone-beam computed tomography imaging. This article also discusses the prevalence, etiology, morphological variations, clinical approach to diagnosis, and significance of supernumerary roots in contemporary clinical dentistry.