Uncommon Canal Anatomy: Identification and Treatment of Middle Distal Canal in Mandibular First Molars-A Report on Two Cases.

Mandibular molars often exhibit high variation in canal anatomy. Failing to identify these variations can negatively impact treatment outcomes. This report describes two cases of mandibular first molars with middle distal canals. In Case 1, the patient was a United Arab Emirates (UAE) national who presented with symptomatic irreversible pulpitis; whereas in Case 2, the patient had a previously treated tooth and chronic apical abscess. Both cases were treated with nonsurgical root canal therapy, and the extra canals were identified using magnification and troughing with ultrasonic tips. In Case 2, healing was observed at the 6 months and 1 year follow-up. This report highlights the lack of data on the incidence of middle distal canals in Emirati population and underscores the importance of meticulous canal exploration and the use of enhanced diagnostic aids to detect atypical canal anatomy.