IJCPD

Anshul Arora et al. 10.5005/jp-journals-10005-1572

CASE REPORT

Radix Entomolaris: Case Report with Clinical Implication

1
Anshul Arora, 2Ashtha Arya, 3Latika Chauhan, 4Gaurav Thapak

ABSTRACT This additional third root is commonly found dis-

tolingual. Radix entomolaris can be found in the first,
Usually first mandibular molars have one mesial and distal root
second, and third mandibular molars, occurring least
but in some cases there are anatomical variations wherein the
number of roots and root canals vary. Presence of an addi- frequently in the second molar. When the extra root
tional lingual root distally in mandibular molars is called radix is present on the mesiobuccal side, it is called as radix
entomolaris (RE). Appropriate diagnosis is must before starting paramolaris. Literature suggests the presence of RE in
with root canal procedure in these teeth to ensure success- less than 5% population in white Caucasian, African,
ful treatment outcome. The report describes the endodontic
Eurasian and Indians whereas it is present with a fre-
management of mandibular molar with RE.
quency of 5–30% in races with Mongoloid traits such
Keywords: Anatomical variation, Endodontic treatment, Man- as the Chinese, Eskimos, and Native Americans.4-7 This
dibular molar, Radix entomolaris.
article highlights the clinical approach for identification
How to cite this article: Arora A, Arya A, Chauhan L, Thapak G. and modifications in endodontic management of man-
Radix Entomolaris: Case Report with Clinical Implication. Int J dibular first molar with RE.
Clin Pediatr Dent, 2018;11(6):536-538
Source of support: Nil CASE REPORT 1
Conflict of interest: None A 27-year-old male patient reported to the Department
of Conservative Dentistry and Endodontics, SGT Dental
INTRODUCTION College, with a chief complaint of severe pain in the right
The main aim of the endodontic procedure is through lower back tooth region since last three days. The pain
the elimination of microbes from the root canal system was intermittent in nature and aggravated on taking hot
and prevention of further reinfection, which is achieved food and beverages, and lasted for 2–3 hours.
by biomechanical cleaning of the pulp space followed by On clinical evaluation, it was seen that there was sec-
hermetic sealing with obturating material. ondary caries associated with restored right mandibular
An awareness and comprehensive knowledge of the first molar. A diagnostic radiograph of mandibular first
unusual root canal morphology can contribute to the molar showed restoration close to pulp and presence of
success of the endodontic procedure. The majority of the an additional root (Fig. 1). Another radiograph was taken
mandibular first molars have one mesial and one distal at 300 mesial and distal angulation to confirm the same.
root with two mesial canals and one distal canal.1,2 Access cavity preparation was done under local anes-
In most cases, the mesial root has two root canals, thesia with an endo access bur (Dentsply, Switzerland).
which may end in two separate apical foramina or they The first distal canal was located towards the buccal side
may merge to form a single foramen at the root end. The indicating the presence of one additional canal on the
distal root generally has one bean shaped root canal. But lingual side.
mandibular molars with a varied number of roots and
root canals have been observed during dental procedures,
though incidences are rare. Carabelli was the first one to
mention the presence of an additional root in mandibular
first molar and called it as radix entomolaris (RE).3

1
Senior Lecturer, 2Reader, 3,4Postgraduate Student
1-4
Department of Conservative Dentistry and Endodontics,
Faculty of Dental Sciences, SGT University, Gurugram,
Haryana, India
Corresponding Author: Anshul Arora, Senior Lecturer,
Department of Conservative Dentistry and Endodontics, Faculty
of Dental Sciences, SGT University, Gurugram, Haryana, India,
Phone: +918860072020, e-mail: anshularora2586@gmail.com
Fig. 1: Preoperative

536
 IJCPD

Radix Entomolaris: Case Report with Clinical Implication

The shape of the access cavity was modified from established as irreversible pulpitis. Radiographic inter-
triangular to a trapezoidal form to locate the fourth canal. pretation revealed the presence of the third root but not
DG-16 endodontic explorer was used to locate the root associated with any periapical changes (Fig. 3).
canal orifices and 15 # K-file (Mani, Japan) was used to Root canal procedure of the tooth was planned and
establish patency of the canals. Working length was deter- patient consent obtained. Local anesthesia was admin-
mined using apex locator (Root ZX, J. Morita) and recon- istered and after access cavity preparation canal orifices
firmed radiographically. Biomechanical preparation was were negotiated with DG-16 explorer. The fourth disto-
done with rotary ProTaper Next (Dentsply, Switzerland) lingual canal orifice was negotiated more lingually, away
file system. During instrumentation, 1.3% sodium hypo- from the rest of the three orifices. The canal lengths were
chlorite was used as an irrigant and 17% EDTA was used determined radiographically with #10 K file, and clean-
as final flush. ing and shaping of the root canal system were done with
Obturation was performed with gutta-percha points rotary ProTaper file system with apical preparation till F2.
using cold lateral condensation technique (Fig. 2). Res- 1.3% sodium hypochlorite was used for disinfection of the
toration of access cavity was done with composite resin pulp space and 17% EDTA was used as a final irrigant.
(tetric-N-ceram, ivoclar vivadent) and a post-obturation After biomechanical preparation, temporary restoration
radiograph was taken. At 6-month follow-up, the patient was done and the patient was recalled after 4 days.
was asymptomatic and radiographic evaluation showed At subsequent appointment patient was asymptom-
no evidence of pathology. atic. Master cone radiograph was taken, canals were dried
with absorbent paper points, and obturation was done
CASE REPORT 2 with gutta-percha cones using AH Plus sealer (Dentsply
A 22-year-old female patient reported to our Department De Trey, Germany) (Fig. 4).
with a history of pain in the lower right back tooth for 1
DISCUSSION
month. On clinical examination, right mandibular first
molar was found to be carious and the diagnosis was Clinical triad of diagnosis, adequate chemomechanical
preparation, and three-dimensional obturation determine
the success of root canal therapy.
The first stage of endodontic triad, i.e., correct diagno-
sis is one of the most important steps towards the success
of the endodontic procedure. One of the main reasons for
the failure of root canal treatment is negligence in remov-
ing pulpal tissue and microbes from all the pulp canals.
Hence, appropriate radiographic diagnosis play a crucial
role in the successful outcome of endodontic therapy.8
So, radiographs were taken at different angulations
to minimize the chances of “missed canals”.9 Radix ento-
molaris has a prevalence rate of less than 5% in the Indian
population and such cases are not commonly observed
Fig. 2: Postoperative during dental treatment. The exact etiology of radix ento-

Fig. 3: Preoperative Fig. 4: Postoperative

International Journal of Clinical Pediatric Dentistry, November-December 2018;11(6):536-538 537

Anshul Arora et al.

molaris is still not known but according to some authors to prevent any lapse in the diagnosis of RE. Thus, an
it may be due to disturbance during odontogenesis or accurate diagnosis and thorough knowledge and about
may be due to the high degree of genetic penetrance.10 the variation in root canal morphology, prevalence and
To avoid any iatrogenic mistake, minimum of two canal configuration of radix entomolaris is prerequisite
angulated diagnostic radiographs are a must along with for endodontic success.
the careful clinical examination. If RE is diagnosed before
commencing the endodontic treatment, a modified trap- REFERENCES
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