Abstract:

Anatomical variations in root canal systems present significant challenges in endodontic treatment and may compromise outcomes if not properly identified and managed. Maxillary second molars typically present with three canals; however, the presence of two palatal canals is a rare variation that may be easily overlooked.
This case report describes the diagnosis and management of a maxillary second molar with two palatal canals in a 62-year-old male patient. The tooth was diagnosed with pulp necrosis and normal apical tissues based on clinical and radiographic examination. Primary endodontic treatment was performed using a minimally invasive approach. Initially, three canals were identified and prepared. Intraoperative radiographic assessment raised suspicion of additional canal anatomy, leading to further exploration and identification of a second palatal canal.
All four canals were instrumented using nickel-titanium rotary instruments and irrigated with standard protocols. The canals were obturated using a bioceramic sealer in combination with gutta-percha. Postoperative radiographic evaluation confirmed adequate filling of all canals. The patient remained asymptomatic at follow-up.
This case highlights the importance of thorough knowledge of root canal anatomy and careful intraoperative assessment in detecting rare anatomical variations. The use of magnification, modern instrumentation, and minimally invasive techniques contributes to successful management of complex canal systems. Failure to identify additional canals may result in persistent infection and treatment failure.
Recognition and proper management of such variations are essential for achieving predictable endodontic outcomes.

Keywords: maxillary molar, palatal canal, endodontics, root canal anatomy, bioceramics