Case Report

Radix Entomolaris In Mandibular First

Reema Malik1,
Harakh Chand Molars: A Case Report
Baranwal2, Amit Raj3
1
Post Graduate Student, Abstract
Department of
Conservative Dentistry Successful root canal treatment depends critically on proper identification of all the
and Endodontics, canals, thorough chemo-mechanical preparation followed by three-dimensional
2
Reader, Department of obturation with hermetic seal. Unable to recognize the unusual tooth morphology
Conservative Dentistry
3 may lead to failure. Usually mandibular molars have two roots with three canals
and Endodontics, Post
Graduate Student, (mesiobucccal, mesiolingual and distal) but in a few teeth, the number of roots and
Department of canals vary. The variation in the number of roots is called Radix Entomolaris. This
Prosthodontics and Oral article presents a case report of mandibular first molars with radix entomolaris.
Implantology, Faculty of
Dental Sciences, Institute Keywords: Anatomical variations, Mandibular molars, Radix entomolaris,
of Medical Sciences, BHU, Endodontic treatment, Variations, Extra roots.
Varanasi-221005.
Correspondence to: Introduction
Dr. Reema Malik,
Department of Root canal treatment is the principal treatment modality that must be preceded by
Conservative Dentistry mechanical and chemical debridement of all the canals before three-dimensional
and Endodontics, Faculty
sealing with an inert filling material. Failure in root canal treatment occurs due to
of Dental Sciences,
Institute of Medical improper cleaning and shaping of canals, lack of understanding of root canal
Sciences, BHU, Varanasi- morphology, failure of establishment of hermetic seal, under-fillings, over-fillings
221005. and also due to improper identification of canals.
E-mail Id: reema.malik10
Most of the mandibular first molars are two-rooted with one mesial root and one
@gmail.com
distal root,1 but number of roots and location of root canals may vary. An additional
third root in mandibular molar first mentioned in the literature by Carabelli is called
the Radix Entomolaris (RE).2 In Radix Entomolaris, the supernumerary root is located
distolingual to the mesial root of the mandibular molars. The other variant of Radix
is Radix Paramolaris in which an extra root is present on the buccal side.3

The present report outlines the diagnosis and endodontic treatment of Radix
Entomolaris.

Case Report
An 18-year-old female patient reported to the Department of Conservative Dentistry
and Endodontics with pain, which was continuous and severe on intake of hot foods
since last 3 days. The patient’s medical history was non-contributory. Clinical
examination revealed the presence of deep carious lesion in left mandibular first
molar. Thermal pulp testing followed by radiographic examination confirmed the
How to cite this article: diagnosis of irreversible pulpitis (Fig. 1).
Malik R, Baranwal, Raj A.
Radix Entomolaris In Non-surgical endodontic therapy was initiated. The patient was given local
Mandibular First Molars: anesthesia of 2% lidocaine with 1:80,000 epinephrine. A conventional endodontic
A Case Report. J Adv Res
access opening was made under isolation with rubber dam (GDC India) and the pulp
Dent Oral Health 2016;
1(3&4): 14-16.
chamber was completely deroofed. The first distal canal was located away from the
center (buccally). This indicated that the other canal will be on the lingual side.
ISSN: 2456-141X Access cavity outline was modified from a triangular shape to a trapezoidal form and
the fourth canal was located. The root canals were located with DG-16 endodontic
explorer and canals were made patent with 15 number K-file (Dentsply Maillefer

© ADR Journals 2016. All Rights Reserved.

J. Adv. Res. Dent. Oral Health 2016; 1(3&4)
Company, USA). Working length was determined
using electronic apex locator Root ZX (J. Morita MFG.
Corporation, Kyoto, Japan) and was confirmed
radiographically (Fig. 2). The root canals were cleaned
and shaped by Rotary Hyflex file system along with
GLYDE (Dentsply Maillefer Company, USA) using
crown-down technique. The root canals were
copiously irrigated with 2.5% sodium hypochlorite.
Calcium hydroxide (Prime Dental Products, Thane)
was placed as intracanal medicament and access
cavity was temporized with Cavit. Patient was recalled
after one week; the tooth was asymptomatic. Root
canals were irrigated again with normal saline and
dried using paper points. Before obturation, master
Figure 1.Pre-operative IOPAR
Figure 3.Master Cone IOPAR
Discussion
The etiology of Radix Entomolaris is still not known.
Some authors believe that it may be due to
disturbance during odontogenesis or may be due to
an atavistic gene. Incidence varies from 5 to 30% and
also among different populations.4 To confirm the
diagnosis of Radix Entomolaris two diagnostic
radiographs are necessary using buccal object rule.
Even the presence of an extra cusp may sometimes
indicate the presence of Radix Entomolaris.
15
Malik R et al.
points were seated to test their suitability to canals
and a radiograph was taken (Fig. 3).
The canals were obturated with selected master
gutta-percha cone (variable taper) and AH-Plus sealer
(Dentsply Maillefer Company, USA) using lateral
condensation technique (Fig. 4). The coronal gutta-
percha cones were sheared off, using heated
instrument, and vertical compaction was done using
heated pluggers at the individual canal orifices. A
temporary restoration with IRM was placed. The
patient was recalled after one week for post-
endodontic restoration, and permanent restoration
was done.
Figure 2.Working Length IOPAR
Figure 4.Post-operative IOPAR
If the presence of Radix Entomolaris has been
confirmed at the diagnostic phase, then the access
cavity shape can be modified and the area to be
searched for the additional canal can be identified.
With a good knowledge of law of symmetry and law
of orifices, various methods like visualizing the
dentinal map and canal bleeding points, using DG-16
explorer, micro-opener, troughing of the grooves with
ultrasonic tips, staining the chamber floor with 1%
methylene blue dye, champagne bubble test,
magnetic resonance microscopy and micro computed
ISSN: 2456-141X
Malik R et al.
tomography will be useful to locate the canals.5
Usually, orifice of the RE is located disto- to mesio-
lingually from the main canal or canals in the distal
root. A severe root inclination or canal curvature,
particularly in the apical third of the root can cause
shaping aberrations such as straightening of the root
canal, ledge formation, root canal transportation,
resulting in loss of working length. Therefore, after
the canal location, orifice enlargement and working
length determination, flexible nickel-titanium rotary
files should be used which allow a more centered
preparation with restricted enlargement of the
coronal third of the root canal.
Conclusion
Clinicians should be aware of the morphological
variations of the tooth like additional roots, root
canals and their incidences. The morphological
variations of the Radix Entomolaris in terms of root
inclination and root canal curvature demand careful,
adapted clinical approach to avoid procedural errors
during endodontic therapy.
Conflict of Interest: Nil
ISSN: 2456-141X
J. Adv. Res. Dent. Oral Health 2016; 1(3&4)
References
1. Vertucci FJ. Root canal anatomy of the human
permanent teeth. Oral Surgery, Oral Medicine,
Oral Pathology1984; 58(5): 589-99.
2. Calberson FL, De Moor RJ, Deroose CA. The radix
entomolaris and paramolaris: clinical approach in
endodontics. Journal of Endodontics 2007; 33(1):
58-63.
3. De Moor R, Deroose C, Calberson F. The radix
entomolaris in mandibular first molars: An
endodontic challenge. International Endodontic
Journal 2004; 37(11): 789-99.
4. Calberson FL, Moor RJ, Deroose CA. The radix
entomolaris and paramolaris: Clinical approach in
endodontics.
5. Wasti F, Shearer A, Wilson N. Root canal systems
of the mandibular and maxillary first permanent
molar teeth of South Asian Pakistanis.
International Endodontic Journal 2001; 34(4):
263-66.
Date of Submission: 29th Dec. 2016
Date of Acceptance: 03rd Jan. 2016
16