Nonsurgical Endodontic Treatment of a Maxillary First Molar With Four Roots, Including Two Palatal Roots, and Five Separate Root Canals: A Case Report

This case report presents a rare maxillary first molar with four separate roots and five root canals: two mesiobuccal canals, one distobuccal canal, and two distinct palatal canals.During initial access preparation, four canal orifices were identified, including the mesiopalatal canal.However, the initial working-length radiograph suggested the presence of an additional distopalatal canal.Subsequent cone-beam computed tomography (CBCT) examination and microscopic exploration assisted by ultrasonic instrumentation facilitated identification of the previously undetected distopalatal canal orifice at the internal distopalatal line angle of the access cavity.The shaping procedure of the root canal treatment was performed using the ProTaper Gold system (Dentsply Maillefer, Ballaigues, Switzerland).The obturation was performed using matched gutta-percha points and a bioceramic sealer.After six months, the patient had no clinical symptoms.This case underscores the possibility of complex anatomical variations in maxillary first molars, which can be addressed through a precise assessment of pulpal floor anatomy and the application of advanced imaging and magnification technologies to minimize the risk of missed canals.