Endodontic management of mandibular first permanent molar with four roots- a distinctive differentia

A comprehensive knowledge and understanding of root canal anatomical variations are essential for the best clinical outcome following root canal treatment. The presence of an extra root/ roots in mandibular first molars is an important and challenging morphological variation, which the clinician should be able to recognize, identify and treat accordingly. A
mandibular first molar with four roots represents a rare anatomical variant. Its incidence is reported to be between 0.2% and 20%. With the advent of cone beam computed tomography (CBCT) as an adjunctive diagnostic aid, the determination of root canal anatomy in teeth with complex canal configurations has become more precise and accurate. The present case report attempts to discuss effective nonsurgical endodontic management of mandibular first molar tooth with four roots employing CBCT as a supplemental diagnostic tool to the conventional intra oral periapical radiographs.