KNOWING THE ABERRATIONS TO AVOID THE SETBACKS - A RARE CASE REPORT ON FOUR ROOTED MANDIBULAR PERMANENT FIRST MOLAR

Aim: The aim of this case report is to present a rare case of a mandibular first molar with four completely separated roots and its successful non- surgical endodontic management. It also emphasizes on the role of radiographs in effectively managing such cases. Background: The successful outcome of a root canal treatment invariably depends on proper identification of the canals, adequate biomechanical preparation and obturation. Though the presence of an extra canal in the mandibular molars has often been reported in literature, but the incidence of four completely separated roots is extremely rare. Case discussion: A 9-year-old male patient visited our department with chief complaint of pain in the lower right back tooth. Intra oral examination showed advanced Class I cavity with exposed pulp in the lower right first mandibular molar with tenderness on vertical percussion with no associated swelling, sinus or fistulous tract. Radiographic examination revealed an interesting finding, that is, the outline of 2 periodontal ligament spaces in both mesial and distal roots with the presence of four separate roots of similar length. Non-surgical endodontic treatment followed by placement of a stainless steel crown was planned for the tooth. Confirmation of the canals length and obturation was done using cone beam computed tomography (CBCT). Conclusion: A thorough knowledge of the intricacies of the root canal morphology is important to the clinician for a successful treatment outcome. These aberrations in root morphology though uncommon do exist and can be missed if thorough radiographic evaluations are not instigated at the initial stages Clinical significance: This case report will tend to reinforce awareness in clinicians on capricious root canal morphology in permanent mandibular first molar.