Dyuti Sikdar, Smriti Rohilla, Arvinder Pal Singh, Himani Lau, Malika Chaudhary
Turkish Endodontic Journal - 2025;10(3):247-253
The ultimate goal of endodontology is to avert and eradicate apical periodontitis and promote periradicular tissue healing. It aims for the reduction of bacterial load and a hermetic three-dimensional filling of the canals. The intricate anatomy of mandibular molars has long posed a challenge in endodontics, particularly with the identification and management of accessory canals. One such aberrancy is the middle mesial canal (MMC) located in the mesial roots of permanent mandibular molars, which has been a subject of intrigue and clinical importance in endodontics. First elaborated by Vertucci et al. and Barker et al. in 1974, the MMC is often overlooked due to its elusive nature and the challenges associated with its detection. A meta-analysis conducted by Al-Maswary et al. in 2023 revealed that the global occurrence of the MMC is 4.4% in permanent mandibular first molars and 1.3% in permanent mandibular second molars. These findings highlight the importance of increased awareness and care-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 insights for their management.
