Non-surgical management of maxillary first molars with five root canals

Aim: This case series reports the non-surgical management of five maxillary first molars with five root canals in different ethnic groups and geographic locations.

Summary: Diagnosis and management of complex root canal anatomy, especially of the maxillary first molar, can be frustrating and challenging and also may increase the risk of failure if not managed with appropriate tools. In this case series the primary endodontic treatment of four, and a non-surgical retreatment of one maxillary first molar with five root canals treated by three different endodontists from India, Spain and Portugal has been described. None of the cases presented in the paper were performed without magnification and troughing of the pulp chamber floor using ultrasonic tips. Although, CBCT wasn’t used in all cases although it’s prudent use respecting the ALARA principle is highlighted in the paper. This paper also highlights the importance of anatomical variations in different ethnic groups with the maxillary first molar. 

Key learning points

• Operator should consider the ethnicity of the patient and thoroughly study pre-operative radiograph to carry out successful endodontic treatment.
• Use of magnification and ultrasonic tips is fundamental especially in treating unusual canal anatomies.
• The prudent use of CBCT should be performed respecting the ALARA principle in all given situations.