Challenges in Managing Additional Roots: Case Reports of Radix Entomolaris and Radix Paramolaris

Authors:  Ben Hadj Belgacem Haythem, Farah Jelalia, Marwa Bouhaha ,Sana Bagga, Saida Sahtout,

Abstract

Introduction :

A clinician should have a proper knowledge of the root canal anatomy and its variations such as extra roots, fins webs, and isthmuses, which make the treatment complicated. Lack of understanding of the root canal morphology and improper shaping and cleaning can lead to the flare-ups.

The most common variations among the mandibular first molars are three roots which were first documented by Carabelli known as radix entomolaris (RE), i.e., the presence of distolingual supernumerary root or mesiobuccal root which is known as radix paramolaris.

Observation:

Through a series of clinical cases, we will illustrate tips on the diagnosis and management of Radix Entomolaris and Paramolaris

Discussion:

–Diagnosis relies on clinical signs like cervical prominences or cusp anomalies.

– A detailed X-ray interpretation is crucial to spot the radix entomolaris (RE), often requiring a second X-ray at a distal angle (30°).

– 3D imaging like CT scans or cone-beam CT can detect RE with less radiation, but cost and availability can be limiting.

– Adjusting access cavities into a trapezoidal shape helps find supernumerary canals.

– Manual preflaring is recommended to prevent instrument separation.

– RE has significant curvature, longer length, and smaller radius, requiring careful preparation to avoid procedural errors like ledging and canal transportation.

– Nickel-titanium rotary files with a taper ≤ 0.04 and the crown-down technique yield more precise canal preparation compared to stainless steel instruments in RE.

TELECHARGER LE PDF.