The case reports present the endodontic management of two maxillary first molars with six canals. The diagnosis of morphology of multiple canal systems was identified under magnification of the dental operating microscope and was confirmed with the help of cone beam computed tomography. This paper discusses the variations in the canal morphology and the use of the latest adjuncts in successfully diagnosing and treating unusual canal anatomy. 1. Introduction A thorough knowledge of the root canal anatomy, its variations, the presence of additional roots, and unusual root canal morphology is essential, as it determines the successful outcome of endodontic treatment [1]. To ensure the long-term success of root canal treatment, it is essential to access, clean, and fill all of the canal spaces. However, the anatomic complexities and variations are constant challenges for successful endodontic therapy [2]. The morphology of the maxillary first molar has been extensively studied and reported in the literature. Traditionally the maxillary first molar exhibits three roots and three canals. The occurrence of a fourth canal ranges from 50.4% to 95% [3–7] and a fifth canal 2.25% [8], and a few authors have also reported cases with 6 canals [9, 10]. The occurrence of 2 canals in distobuccal root has been less frequent and has been reported in 3.6% of maxillary molars [4, 10, 11]. Palatine root canal variations were well established by Christie et al. [8, 12], who reported the endodontic treatment of maxillary molars with 2 palatine roots and classified these teeth as types I, II, and III, according to root degree of divergence. Others reported cases of maxillary first molar with two canals in each of the three roots [9, 10, 13–15]. The present cases report the successful management of maxillary first molars with three roots and six canals. The clinical findings were confirmed with the help of operating microscope and cone beam computed tomography (CBCT). 2. Case Report 1 A 43-year-old female patient presented with the chief complaint of pain in the left upper back tooth. The pain was continuous and aggravated on heat stimulation. The patient also complained of pain at night. The patient’s medical history was noncontributory. Clinical examination revealed the left maxillary first molar with a deep carious lesion which was tender on percussion. Electric pulp testing gave a premature response, indicative of inflammatory pulpal changes. The radiographic examination revealed a radiolucent lesion on the mesial aspect of the crown extending to the pulp (Figure 1(a)).
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