Anatomical abnormalities of a maxillary first molar with seven distinct root canals: a rare clinical case

Root canal treatment is the most commonly used method for the treatment of dental pulp diseases. However, abnormalities in root canal anatomy frequently occur in posterior teeth, especially in maxillary first molars. The complex diversity of root canal system poses challenges for successful root canal treatments and potentially leads to postoperative complications. A 30-year-old female patient experienced prolonged bite discomfort following root canal treatment on her left maxillary first molar (tooth #14) one year ago. Panoramic radiograph revealed underfilling of the mesio-buccal (MB), disto-buccal (DB) and palatal (P) canals. Endodontic retreatment, employing a dental operating microscope (DOM) and ultrasound, was undertaken. Another four missed root canals were found. Disto-buccal and palatal roots had Vertucci type IV canal pattern, and mesio-buccal root had Vertucci type VIII pattern. Following completion of the root canal treatment, the patient's biting pain resolved. Variations in root canal anatomy are prevalent in maxillary first molars. Utilizing the DOM for meticulous examination of the pulp chamber floor is crucial in preventing oversight of such variations and is instrumental in ensuring the success of root canal treatments. DOM was highly recommended while performing multicanal endodontic cases, which could enhance the operator's visualization and improve the success rate.