Brazilian Journal of Dentistry and Oral Radiology. 2024, 3, 1, bjd50. www.bjdentistry.com.br

Clinical Image

trifid mandibular canals. C. On the right side of the image, red arrows clearly point out

the three distinct branches of the trifid mandibular canal. On the left side, black arrows

indicate the three branches of the trifid mandibular canal, providing precise identification

of each branch. D. An orthoradial slice on the right side of the mandible displaying a

trifurcated root canal. The image clearly reveals three distinct branches of the root canal,

indicating a complex anatomy.

nificant pain during previous dental procedures on her lower teeth. During the clinical

examination, multiple missing teeth were observed (15, 16, 17, 18, 25, 27, 28, 36, 37, 38,

and 48). Additionally, a cavitated carious lesion was found on tooth 23, which was painful

to vertical percussion, cold, and heat. A routine panoramic radiograph (Fig. 1) revealed

an apparent bifid mandibular canal (BMC) on the right side and a trifid mandibular canal

(TMC) on the left side, an anatomical variation of the mandibular canals. Unfortunately,

a computed tomography scan could not be requested as this technology is not yet available

in the country. Subsequently, a cone beam computed tomography (CBCT) was requested,

which confirmed the bila-teral presence of trifid mandibular canals (Fig. 2). Initial treat-

ment included scaling, polishing, and fluoride application. During the subsequent visit,

mandibular canal [2]. The term "bifid" comes from Latin and means a division into two

parts or branches. Bifid mandibular canals start at the mandibular foramen and can hold

a neurovascular bundle in each branch [3]. The BMC can be identified in panoramic

radiographs. Cross-sectional tomographic images perpendicular to the alveolar ridge pro-

vide more detailed information about the mandibular canal and its precise pathway [3].

The initial screening to identify BMCs can be conducted using conventional panoramic

radiography. If BMCs are diagnosed, it is advisable to perform additional cone beam com-

puted tomography (CBCT) before proceeding with mandibular surgery.

In addition to detecting BMCs, CBCT can also reveal the presence of TMCs and

provide detailed insights into the exact path of the involved canals [4]. BMC and TMC

vascular bundle in bifid canals [3].

When dentists encounter anesthesia failure while attempting mandibular nerve

block in patients with BMC and bifurcated mandibular nerve (BMN), they should con-

sider using an alternative local anesthesia technique [5]. It’s also important to consider

TMC, as these variations can make standard anesthesia techniques less effective and may

require more tailored approaches. Additionally, the use of alternative local anesthetics

such as articaine is suggested. It is important for dentists to be aware of this anatomical

variation and to recognize it to avoid complications during dental procedures. This case

emphasizes the importance of knowing and identifying anatomical variations such as the

bifid mandibular canal to ensure appropriate patient management and prevent potential

Research Ethics Committee Approval: We affirm that the participant consented to the

research by endorsing a clear consent document, and the investigation adhered to the

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