case_images: PMC10850443_01
case_images: The preoperative periapical radiograph of the upper right first molar.. The tooth has four roots, indicated as follows: the mesiobuccal root (marked by a red arrow), the distobuccal root (yellow arrow), the mesiopalatal root (green arrow), and the distopalatal root (blue arrow). Notably, the palatal roots are widely spaced. The apices of the mesiobuccal, distobuccal, and mesiopalatal roots exhibit a distal curvature, collectively resembling the shape of cow horns.
case_images: cureus-0016-00000051907-i01.jpg
case_images: PMC10850443_01_cureus-0016-00000051907-i01.jpg
case_images: FIG1
case_images: The cross-sectional (A) and sagittal (B) views of cone-beam computed tomography (CBCT).. The cross-sectional view (A) of CBCT reveals that the upper right first molar has four roots, indicated as follows: the mesiobuccal root (marked by a red arrow), the distobuccal root (yellow arrow), the mesiopalatal root (green arrow), and the distopalatal root (blue arrow). In contrast, the upper left first molar (white arrow) has two buccal roots and a single palatal root. The sagittal view (B) of CBCT shows that the mesiopalatal root (green arrow) and the distopalatal root (blue arrow) of the upper right first molar are widely spaced apart.
case_images: cureus-0016-00000051907-i02.jpg
case_images: PMC10850443_01_cureus-0016-00000051907-i02.jpg
case_images: FIG2
case_images: CBCT confirmed four roots in the upper right first molar, including the double palatal roots, while the upper left first molar had three roots with a single palatal root (Figure 2A). The CBCT also revealed that the double palatal roots of the upper right first molar were widely spaced (Figure 2B).
case_images: The intraoral photograph.. The upper right first molar has a sixth cusp near the mesial side of Carabelli's cusp (indicated by the yellow arrow). In contrast, the opposing upper left first molar only has Carabelli's cusp and does not exhibit a sixth cusp.
case_images: cureus-0016-00000051907-i03.jpg
case_images: PMC10850443_01_cureus-0016-00000051907-i03.jpg
case_images: FIG3
case_images: An intraoral photograph was taken (Figure 3), and the tooth was isolated with a rubber dam (Kerr, USA).
case_images: Microscopic photograph.. The pulp floor is shown with the mesiobuccal (MB) and distobuccal (DB) root canal orifices.
case_images: cureus-0016-00000051907-i04.jpg
case_images: PMC10850443_01_cureus-0016-00000051907-i04.jpg
case_images: FIG4
case_images: Under the microscope, four root canal orifices in a trapezoidal arrangement were observed on the pulp floor, with the two palatal root canal orifices notably distant (Figures 4, 5).
case_images: Microscopic photograph.. The pulp floor is shown with two palatal root canal orifices, mesiopalatal(MP) and distopalatal (DP), being notably distant from each other.
case_images: cureus-0016-00000051907-i05.jpg
case_images: PMC10850443_01_cureus-0016-00000051907-i05.jpg
case_images: FIG5
case_images: Under the microscope, four root canal orifices in a trapezoidal arrangement were observed on the pulp floor, with the two palatal root canal orifices notably distant (Figures 4, 5).
case_images: The periapical radiograph for working length confirmation.. The working length of each canal is accurately determined by inserting a K-file into the canal and confirming its length.
case_images: cureus-0016-00000051907-i06.jpg
case_images: PMC10850443_01_cureus-0016-00000051907-i06.jpg
case_images: FIG6
case_images: Tokyo, Japan), and a periapical radiograph was taken to confirm the working length (Figure 6).
case_images: The postoperative radiograph of the upper right first molar. . All four root canals are properly filled, with the two buccal canals exhibiting severe curvature.
case_images: cureus-0016-00000051907-i07.jpg
case_images: PMC10850443_01_cureus-0016-00000051907-i07.jpg
case_images: FIG7
case_images: The root canal filling was completed using the continuous wave obturation technique with Elements Obturation Unit (SybronEndo), and a periapical radiograph was taken to evaluate the quality of root canal filling (Figure 7).