Endodontic management of mesial middle canal in mandibular molars with symptomatic irreversible pulpitis

Aim: This article aims to present three endodontic treatment cases of mandibular molars with three mesial canals and two distal canals.

Summary: Three patients were admitted in our clinic with a description of toothache while having hot and cold drinks. Clinical examinations revealed deep decay of teeth, but no pain to percussion. Radiographic images confirmed an intact periapical tissue with deep decay in each tooth, and teeth were diagnosed as symptomatic irreversible pulpitis. Root canal treatments were completed in single appointments. Studies suggest that mandibular molars with MMCs could be recognized more precisely with CBCT. Endodontic treatment of mandibular molars with mesial middle canal (MMC) can cause various challenges for every clinician, thus a proper understanding of root canal anatomical variations is a cornerstone in reaching endodontic success.

Key Learning Points:

• To identify the presence of an MMC, the isthmus between the ML and MB canal should be probed with a straight endodontic probe. In case of engagement of the probe at a specific point, it may be legitimate to look for the presence of the MMC.
• In root treatments, it is important not only to recognize the shape of the root canals, but also the variations of their course and possible fusion, respectively.
• It is of great importance to pay attention to the possible existence of an isthmus between the root canals, which must be completely cleaned and filled.