Endodontic Enigma: A Mandibular First Molar with Six Canals – Middle Mesial and Middle Distal Canal
Abstract
Mandibular first molars typically exhibit two mesial and one or two distal canals. However, the simultaneous presence of both a middle mesial (MM) and middle distal (MD) canal—resulting in six distinct canals—is extremely rare and poses a diagnostic and clinical challenge. This case report describes the endodontic management of a 45-year-old male patient who presented with pain in the lower right posterior region for one month. Clinical and radiographic examination led to a diagnosis of chronic irreversible pulpitis with symptomatic apical periodontitis. Non-surgical root canal treatment was initiated. Exploration under a dental operating microscope (DOM) initially revealed four canals. Further examination, along with the champagne bubble test and selective troughing using ultrasonics, revealed hemorrhagic points that led to the identification of additional MM and MD canals. All six canals were negotiated, cleaned, shaped, and obturated successfully. This case emphasizes the importance of clinician awareness regarding anatomical variations and highlights the critical role of DOM, cone-beam computed tomography (CBCT), and modified access cavity designs in locating and managing additional root canals to enhance treatment success.
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BibTeX
@article{nandakishore2026endodontic,
title = {{Endodontic Enigma: A Mandibular First Molar with Six Canals – Middle Mesial and Middle Distal Canal}},
author = {Arjun Nandakishore and Deepali Agarwal and Ashwin Nandakishore},
journal = {Medical Journal of Dr. D.Y. Patil Vidyapeeth},
year = {2026},
month = sep,
doi = {10.4103/mjdrdypu.mjdrdypu_920_25},
url = {https://doi.org/10.4103/mjdrdypu.mjdrdypu_920_25},
note = {CC BY-NC-SA},
}
RIS
TY - JOUR
TI - Endodontic Enigma: A Mandibular First Molar with Six Canals – Middle Mesial and Middle Distal Canal
AU - Arjun Nandakishore
AU - Deepali Agarwal
AU - Ashwin Nandakishore
PY - 2026
DA - 2026/09/01
JO - Medical Journal of Dr. D.Y. Patil Vidyapeeth
DO - 10.4103/mjdrdypu.mjdrdypu_920_25
UR - https://doi.org/10.4103/mjdrdypu.mjdrdypu_920_25
AB - Mandibular first molars typically exhibit two mesial and one or two distal canals. However, the simultaneous presence of both a middle mesial (MM) and middle distal (MD) canal—resulting in six distinct canals—is extremely rare and poses a diagnostic and clinical challenge. This case report describes the endodontic management of a 45-year-old male patient who presented with pain in the lower right posterior region for one month. Clinical and radiographic examination led to a diagnosis of chronic irreversible pulpitis with symptomatic apical periodontitis. Non-surgical root canal treatment was initiated. Exploration under a dental operating microscope (DOM) initially revealed four canals. Further examination, along with the champagne bubble test and selective troughing using ultrasonics, revealed hemorrhagic points that led to the identification of additional MM and MD canals. All six canals were negotiated, cleaned, shaped, and obturated successfully. This case emphasizes the importance of clinician awareness regarding anatomical variations and highlights the critical role of DOM, cone-beam computed tomography (CBCT), and modified access cavity designs in locating and managing additional root canals to enhance treatment success.
SN - 2589-8302
SN - 2589-8310
ER -