The Radix entomolaris and paramolaris: clinical approach in endodontics

By Calberson F, De Moor R, Deroose C

Date: 10/2007
Journal: JOE

Summary: 

Purpose: to present three cases of mandibular molars with a radix entomolaris (RE) or paramolaris (RP) requiring RCT.

•The radix entomolaris is an additional root located lingually. the radix paramolaris is an additional root located buccally

Case 1:  A 34 y Caucasian male was referred for endodontic treatment of #46. Access cavity was prepared and 3 canal orifices were located (2M &1D). With the aid of the microscope, a dark line was observed between the distal canal orifice and the distolingual corner of the pulpal floor. At this corner overlying dentin was removed and a second distal canal orifice was detected. WL was determined and the root canals were shaped with ProTaper rotary instruments and filled with GP using hybrid condensation technique. The unusual location of the orifice far to the disto-lingual indicated a supernumerary root, and the presence of RE was confirmed on the postoperative radiograph.

Case 2: A 35 y Caucasian male was referred for endodontic treatment of #46. Access cavity was prepared and four distinct canal orifices were found (2M & 2D). Insertion of the file in the fourth, distolingual canal showed a more lingually oriented access inclination. Upon removal of the file, the tip was deformed with a strong curvature to the mesial. This, together with the different access inclinations between the two distal canals, indicated the presence of two separate distal roots. RCT was performed as in case 1, the gutta cone fit RG (with 30° mesial angulation) confirmed the presence of RE.

Case 3:  A 50 y Caucasian male was referred for endodontic treatment of #37. access prepared,  Inspection of the pulp chamber wall with a microscope and an angled probe revealed an overlying edge of the pulp chamber roof on the mesiobuccal, the access cavity enlarged and another canal orifice was found, Radiographical length determination showed a separate buccal root, identified as RP.

Clinical significance:

accurate diagnosis of RE and RP is important to avoid the complication of a “missed canal”.  Deep interpretation of the preoperative RG using multiple angulation, periodontal probing of CEJ and the use of visual aids such as a loupe or microscope can aid in detection of these additional roots.