A trilogy tale: Middle mesial canals in permanent mandibular molars - A case series

The mandibular molars are often conferred with varied anatomies and are more prone to be subject to an endodontic intervention. Therefore, familiarity with these varying aberrant morphologies is of utmost importance to an endodontist. The complex anatomy of permanent mandibular molars, particularly the existence of the middle mesial canals (MMCs), presents significant challenges in endodontic treatment. MMCs can be classified into one of the three types: Fin, confluent, and independent, with the last being the rarest. Inadequacy to identify and treat these canals can precipitate persistent infection and subsequent endodontic failure. This article presents three clinical cases elucidating the detection and management of MMCs in permanent mandibular molars. Advanced diagnostic techniques, including magnification, ultrasonic troughing, and cone-beam computed tomography, can be diligently used to locate and negotiate these canals. All cases involved meticulous cleaning, shaping, and obturation, resulting in successful outcomes. The discussion emphasizes the importance of a systematic approach to canal exploration, the use of modern imaging modalities, and conservative instrumentation to preserve root integrity. The identification and treatment of MMCs are critical for predictable endodontic outcomes. This article underscores the significance of MMCs in endodontics and provides practical in-sights for their management.

Keywords: Cone-beam computed tomography, endodontic failure, middle mesial canal, permanent mandibular molars, root canal anatomy.