C-shaped Root Morphology with Four Canals in Mandibular First Molar: A Rare Case Report

Aim of this case report is to present an unfamiliar case of mandibular first molar with a C-shaped root having four canals. Root canal system (RCS) is generally very complex, and it is always important for every practitioner who perform root canal treatment to have a knowledge of unusual variations in the root anatomy and root canal configuration, such as the C-shaped configuration. The frequency of C-shaped root canals is more common in mandibular second molars but very rare in mandibular first molars. A 28-year-old male patient presented with a history of spontaneous pain, intermittent in nature, in the right mandibular first molar region, for about 2 months. On clinical inspection, a large, carious lesion was noted distally in the mandibular first molar and was nonresponsive to percussion. A preoperative orthopantomograph (OPG) confirmed the involvement of pulp with widening of PDL space, and hence was diagnosed as symptomatic irreversible pulpitis with asymptomatic apical periodontitis. A nonsurgical endodontic treatment was planned. During access cavity preparation, four distinct orifices were located in the pulp chamber, which was not uncommon and hence, proceeded with obturation by the cold lateral compaction method and access cavity restoration with resin composite. Though the initial preoperative OPG or clinical examination of the access cavity did not reveal any significant morphological variation, on contrary, master-cone check radiograph had a different view from the common variation of the mandibular molar. Hence, postoperative cone beam computed tomography was conducted to verify the same, which revealed a C-shaped root with four canals, a rare morphological and unfamiliar variation of the mandibular first molar. An awareness and understanding of this unusual root and its root canal morphology can contribute to the successful outcome of root canal treatment. Knowledge of root morphology and the configuration of the pulpal space play an important role in ensuring thorough debridement and the outcome of root canal treatment. How to cite this article: Ravi SV, Honwad S. C-shaped Root Morphology with Four Canals in Mandibular First Molar: A Rare Case Report. J Contemp Dent Pract 2024;25(11):1077-1080.