Endodontic Management of a Less Common Four-Rooted Maxillary Second Molar

This case report presents a less common anatomical variation in a maxillary second molar (MSM) characterized by four roots - two buccal and two palatal - and four distinct canals. The report emphasizes the significance of advanced diagnostic imaging and careful clinical evaluation in identifying and managing less common anatomical variations in maxillary second molars. Specifically, it presents the endodontic management of an MSM with two buccal and two separate palatal roots - detected using a cone beam computed tomography (CBCT) - underscoring the importance of comprehensive canal mapping and precise diagnosis in achieving treatment success. A 40-year-old male patient presented with intense pain in the upper right second molar, as reported by his general dentist. Clinical examination showed moderate pain on percussion and palpation. The radiological examination by CBCT scan revealed four separate roots and canals (two buccal and two palatal), with three canals filled with calcium hydroxide (Ca(OH)₂). Non-surgical root canal treatment was approached for the endodontic treatment. The nine-month follow-up showed resolution of all symptoms without pain on percussion and palpation. We conclude that a comprehensive understanding of the complex root canal morphology of MSMs is crucial for achieving successful endodontic outcomes. While common variations include three roots and three canals, less frequent configurations, such as a single root or four distinct roots with separate canals, emphasize the importance of comprehensive assessment. The prognosis currently demonstrates a higher success rate due to advancements in endodontic instruments and materials. Several factors play a role in success rate, such as the operator's experience, the number and location of canals, the treatment duration, and the utilization of tools like a microscope and CBCT, which can enhance the chances of achieving higher success rates in managing unusual variations of MSM.