I. Introduction
High levels of success in endodontic treatment require an understanding of the root canal anatomy and morphology and the whole root canal system must be debrided, disinfected, and filled. Thus, it is necessary for the clinician to have knowledge of not only the normal anatomy but also its variations. A radiographic study of extracted teeth reported mandibular first molars had three mesial canals in 13.3% of specimens and three distal canals in 1.7% of specimens. This case describes a mandibular first molar with 3 separate mesial and 3 separate distal canals related to BRONJ.
II. Case presentation
1. Sex/age: F/73
2. Chief Complaint: For evaluation of #46 sinus tract
3. Past Medical History: Bisphosphonate medication for osteoporosis
4. Past Dental History: 10MA #44,45 extraction due to pus discharge, but pus discharge persisted
9MA #44,45 area saucerization for BRONJ
5. Present Illness: #45 edentulous lingual gingiva sinus tract formation from #46 mesial canal
#46 periapical lesion and per (+)
6. Impression: #46 periapical abscess with sinus to oral cavity
7. Treatment Plan: #46 root canal treatment
8. Treatment Progress: Although treating six canals in #46, sinus tract did not disappear.
So, after consulting with OMFS, additional saucerization and #46 apicoectomy was planned.
But, because widespread sequestrum was existed, #46 was extracted.
III. Conclusions
Although the frequency of 6 canals is rare, morphological variations in pulpal anatomy must always be considered before beginning treatment. And periapical abscess with sequestrum related to BRONJ rarely be healed by root canal treatment only.
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