Identification of anatomical variation of radix entomolaris in a clinical case of endodontic treatment

Abstract

The radix entomolaris is an anatomical variation characterized by the presence of a third root in mandibular molars, primarily in the first molars. Its identification is crucial to avoid failures in endodontic treatment, as its omission can compromise the cleaning, shaping, and obturation of the root canal system. The objective of this study was to identify the anatomical variation known as radix entomolaris in a patient undergoing endodontic treatment to document its implications in diagnosis and clinical management. The case of a 24-year-old male patient referred for endodontic retreatment of a left mandibular first molar due to persistent symptoms was analyzed. The initial radiographic evaluation suggested inadequate obturation and, through cone-beam computed tomography, the presence of an uninstrumented radix entomolaris was confirmed. A new endodontic access was performed with absolute isolation, using ultrasonic tips to locate the accessory canal. Instrumentation was carried out with rotary files and irrigation with 2.5 % sodium hypochlorite and 17 % EDTA-T. Obturation was performed using the continuous wave condensation technique, achieving adequate three-dimensional sealing. It is concluded that this case highlights the importance of using advanced diagnostic tools for the detection of root anatomical variations, and that computed tomography and the use of specialized endodontic technologies optimize clinical management, improving treatment prognosis and reducing the risk of endodontic failures.