anand Marya - Academia.edu (original) (raw)

Papers by anand Marya

Research paper thumbnail of Functional Significance of the Curve of Spee: Electro-myographic Analysis of Young Adults-A Preliminary Study

An analysis of the curve of Spee in relation to muscle activity, assessed by electromyographic an... more An analysis of the curve of Spee in relation to muscle activity, assessed by electromyographic analysis, on a group of 16 young adults with previous fixed orthodontic treatment is proposed as a pilot study. Given the high incidence of this type of dental treatment, it is important to point out how, in this field of dentistry, there is a marked tendency to level and flatten this anatomical occlusal curve, as proposed by Andrews. If in orthodontics there is a standardized levelling of the curve of Spee, in the prosthetic and restorative field, the management of the curve of Spee requires greater attention and often even an individualized approach. The purpose of this study is to investigate what the levelling of the antero-posterior occlusal curve entails in terms of masticatory effectiveness and harmony. From the results obtained, it can be seen that in order to optimize the harmony of the stomatognathic apparatus, the curve of Spee is a parameter that requires individual attention: modifying it through standardized levelling has inevitable consequences.

Research paper thumbnail of Non-extraction orthodontic treatment for severe dental crowding using miniscrew-assisted rapid maxillary expansion

PubMed, Nov 1, 2022

Malocclusion is caused by an incorrect relationship between the teeth and jaws, which leads to an... more Malocclusion is caused by an incorrect relationship between the teeth and jaws, which leads to an abnormal variation of normal occlusion. Crowding is an increasingly common type of malocclusion caused by a discrepancy in tooth-jaw size that leads to twisted and misaligned teeth. Two methods to treat this malalignment are tooth material reduction and arch width expansion. Of these two treatment options, the latter is preferred because it enables orthodontists to avoid extractions and increase the dental arch perimeter by widening the jaws; this resolves crowding and accommodates existing teeth. This case report describes a unique approach in the treatment of a patient with severe crowding by an orthopaedic widening of the dental arches using a skeletally anchored rapid palatal expander. Under favorable circumstances, this approach can serve as a robust method to treat patients with severe crowding and may be used as an alternative to extraction.

Research paper thumbnail of AGPs and orthodontics

British Dental Journal, Aug 1, 2020

Research paper thumbnail of Growth differentiation factor-15 as predictor of periodontal treatment effects in patients with periodontitis: a randomized-controlled clinical trial

Research Square (Research Square), Mar 13, 2023

Background: It has been shown that periodontal treatment could potentially decrease the risk of d... more Background: It has been shown that periodontal treatment could potentially decrease the risk of developing cardiovascular disease (CVD) and that growth differentiation factor 15 (GDF-15) is a valuable biomarker of early CVD risk. This study evaluated the e cacy of periodontal treatment on growth differentiation factor 15 (GDF-15) and related circulating systemic risk biomarkers such as glutathione peroxidase 1 (GPx-1), c-reactive protein (hs-CRP), and surfactant protein D (SP-D) and explored whether patients with high GDF-15 at baseline showed increased clinical bene ts with two non-surgical treatments protocols at 6-months follow-up. Methods: Patients with periodontitis were randomized to receive quadrant (Q-SRP, n=23) or full-mouth disinfection (FMD, n=23) protocols. Clinical and periodontal parameters were recorded in all enrolled patients. Serum concentrations of GDF-15, GPx-1, hs-CRP, and SP-D concentrations were assessed at baseline and 30, 90, and 180-days follow-up through enzyme-linked immunosorbent assay (ELISA) and nephelometric assay techniques. Results: Q-SRP was more effective than FMD in lowering periodontal parameters, and the mean proportions of GDF-15 (p=0.005), GPx-1 (p=0.025), hs-CRP (p<0.001), and SP-D (p=0.042) after 6 months of treatment. Periodontal parameters were signi cantly associated with concentrations of GDF-15, GPx-1, hs-CRP, and SP-D at 6-months follow-up. Furthermore, the ANOVA analysis revealed that Q-SRP signi cantly in uenced the upregulation of GPx-1 and on downregulation of GDF-15, and SP-D and substantially impacted the effectiveness of periodontal therapy at 6 months follow-up. Conclusion: The results evidenced that, in comparison with FMD, Q-SRP was more effective at reducing periodontal variables and positively impacting GDF-15, GPx-1, hs-CRP, and SP-D concentrations, although patients who exhibited higher GDF-15 and SP-D and lowered GPx-1 at baseline, more bene ted the effects of periodontal treatment at 6-month follow-up.

Research paper thumbnail of Patient consent

British Dental Journal, May 27, 2022

Research paper thumbnail of Canine trends in SE Asia

British Dental Journal, Mar 1, 2021

Research paper thumbnail of Flipped classrooms

British Dental Journal, May 13, 2022

Research paper thumbnail of Unaffected in Cambodia

British Dental Journal, Nov 13, 2020

Research paper thumbnail of Satisficing and bots

British Dental Journal, Jan 28, 2022

Research paper thumbnail of Rare non-syndromic bilateral maxillary and mandibular permanent canine agenesis

Authorea (Authorea), Mar 31, 2022

Research paper thumbnail of South East Asia

British Dental Journal, Apr 1, 2021

Research paper thumbnail of Biomolecular and Biochemical Aspects of the Oral Cavity

Molecules, Dec 8, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Research paper thumbnail of Dental Luting Cements: An Updated Comprehensive Review

Molecules, Feb 8, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Research paper thumbnail of Channa Striata and Hyperbaric Oxygen Therapy Combination for Pressure Areas in Orthodontic Treatment

Pesquisa Brasileira em Odontopediatria e Clínica Integrada

To study the effect of using a combination of Channa Striata gel and hyperbaric oxygen therapy on... more To study the effect of using a combination of Channa Striata gel and hyperbaric oxygen therapy on pressure areas during orthodontic treatment. Material and Methods: The study was conducted using the ARRIVE Essential 10 guidelines. In this study, 35 3-4 months male guinea pigs (Cavia Cobaya) weighing 300-400 grams were used and divided into 5 groups (n=7). Decalcification was performed to dissolve the dental calcium and jawbone to cut the tissue properly. The decalcification was performed for 30 days. Then preparations were made with HE (Hematoxylin Eosin), observed using a microscope, and counted the number of osteoclasts and macrophages on a light microscope with 400 times magnification. The results of the preparations were analyzed using the SPSS program. Results: The Kruskal-Wallis test of macrophage cells and the ANOVA test of osteoclast cells showed significant results between all groups (p<0.05). Conclusion: The effect of hyperbaric oxygen therapy 2,4 ATA administered on days 8-14 and Channa Striata extract gel administered on days 3-14 can increase the number of macrophages in the periodontal ligament and osteoclasts in the alveolar bone in the pressure area during orthodontic tooth movement.

Research paper thumbnail of Measuring tooth size discrepancies using Bolton analysis: a comparative cross-sectional study among major ethnicity in Malaysia

BMC Oral Health

Background The Bolton analysis is one of the commonly used tooth size analysis or diagnostic tool... more Background The Bolton analysis is one of the commonly used tooth size analysis or diagnostic tools in deriving a treatment plan for orthodontic patients. Many studies have indicated and concluded that normal measurements for one group should not be considered normal for other ethnic groups. The aims and objectives of this study were to investigate the applicability of Bolton’s ratios in the orthodontic population of Malaysian main ethnics, Malay, Chinese, and Indians. Comparisons were made in terms of size and distribution of tooth size discrepancy in the Malaysian orthodontic population and the findings were converted in terms of millimeters. Methods Hundred fifty pre-orthodontic study casts comprised of 52 Malay, 54 Chinese, and 44 Indian patients were selected. Digital calipers (Fowler Pro-Max) linked to Hamilton Tooth Arch Software were used to measure the tooth width and ratios. Statistical analysis was carried out to test for gender differences (independent t-test), to identif...

Research paper thumbnail of Complications associated with the surgical removal of non-syndromic supernumerary premolar tooth buds in the mandible

Journal of Surgical Case Reports

Hyperdontia involving the premolar teeth can be single or multiple or even related to a syndrome.... more Hyperdontia involving the premolar teeth can be single or multiple or even related to a syndrome. These are frequently encountered in permanent dentition, but their occurrence has ranged between 0.09 and 0.64% in the general population. These are commonly found between the permanent canines and first premolars but rarely between the first and second premolars. These are usually eumorphic and can be easily identified as they follow the conventional tooth morphology. These are usually asymptomatic and not easily palpable unless they are very close to eruption. A lingual approach is preferred during their removal over the buccal method as it poses less risk of root trauma. In this case, bilateral accessory premolar tooth buds were present between the first and second premolars. Since the patient was undergoing orthodontic treatment, she was advised to remove these accessory teeth. For their removal, a Neumann flap with a buccal approach was used, which led to fracturing the root apex o...

Research paper thumbnail of Interdisciplinary orthodontics-implants management of a challenging hypodontia case complicated by a class II division 2, bimaxillary retroclination

International Orthodontics

Introduction &gt; The case in thisstudy had moderate hypodontia, with both lower lateral inci... more Introduction &gt; The case in thisstudy had moderate hypodontia, with both lower lateral incisors and the lower-left second premolar missing. A Class II division 2 relationship with severe crowding in the upper arch and a traumatic deep bite over a skeletal I base complicated the occlusion. Materials and methods &gt; The plan was to extract the upper first premolars to relieve upper arch crowding and the lower-left impacted second premolar to preserve the bilateral class I molar relationship. A class I occlusal relationship was achieved through space opening in the lower lateral incisors region and space closure in the upper and lower premolars regions. Results &gt; The use of orthodontic screws for bite opening and anterior segment retraction, in conjunction with bi-metric slot size selection in bracket prescription, was effective in controlling incisor inclination and interincisal angle. The use of an implant fixture before beginning the finishing stage allowed for a reduction in total treatment time and facilitated the provision of the final prosthesis before debonding the case. As a result, the patient was able to receive a satisfactory occlusion on the day of debonding. Conclusion &gt; This case of moderate hypodontia was successfully resolved by combining space closure and space opening effectively. To solve the arch problems in such Class II division 2 cases with severe crowding, extractions were required. To complete the case, this was combined with intrusive and retractive mechanics. In hypodontia cases, implants are an excellent choice for both aesthetics and functional restoration.

Research paper thumbnail of The Evaluation of Clinical Signs and Symptoms of Malignant Tumors Involving the Maxillary Sinus: Recommendation of an Examination Sieve and Risk Alarm Score

Healthcare

This observational study was conducted to evaluate the clinical signs and symptoms of maxillary s... more This observational study was conducted to evaluate the clinical signs and symptoms of maxillary sinus tumors and to propose a clinical examination sieve and a unique risk alarm score to be used for timely patient referral and vigilance. The study consisted of 70 patients between 20 to 82 years of age from both sexes. The clinical information gained was collected from the upper dentoalveolar segment, orbit, and nasal sites. Regarding the early clinical sign and symptoms of patients, nasal obstruction was found in 67 patients (95.7%), facial swelling in 69 patients (98.6%), paresthesia in 41 patients (58.6%), and epistaxis in 50 patients (71.4%). Furthermore, in terms of the late signs and symptoms, a palpable mass in buccal sulcus was observed in 65 (92.9%) of the patients, lymphadenopathy in 24 (34.3%), paresthesia in 38 (54.3%), and diplopia in 22 (31.4%). Furthermore, general sign and symptoms like exophthalmos was present in 35 patients (50%), anosmia was observed in 37 patients ...

Research paper thumbnail of 3D Bitemark Analysis in Forensic Odontology Utilizing a Smartphone Camera and Open-Source Monoscopic Photogrammetry Surface Scanning

Brazilian Research in Pediatric Dentistry and Integrated Clinic, 2023

Research paper thumbnail of Variation in Location of the Distobuccal Root Canal in a permanent Maxillary Second Molar: A Case Report and Literature Review

This case report describes the unusual location of the distobuccal root canal in a maxillary seco... more This case report describes the unusual location of the distobuccal root canal in a maxillary second molar with root fusion. On access opening, three distinct root canal orifices, the mesiobuccal canal, palatal canal, and a third orifice closer to the palatal canal, were seen, giving an illusion of an additional palatal canal. An attempt was made to search for the distobuccal canal in its usual position, leading to the gouging of the pulp chamber floor. An intra-operative limited field of view cone-beam computed tomography (CBCT) revealed the root orifice adjacent to the palatal canal was the distobuccal canal. CBCT also revealed fusion of both the buccal and palatal roots in the root's coronal and middle third region, but they were not fused apically.

Research paper thumbnail of Functional Significance of the Curve of Spee: Electro-myographic Analysis of Young Adults-A Preliminary Study

An analysis of the curve of Spee in relation to muscle activity, assessed by electromyographic an... more An analysis of the curve of Spee in relation to muscle activity, assessed by electromyographic analysis, on a group of 16 young adults with previous fixed orthodontic treatment is proposed as a pilot study. Given the high incidence of this type of dental treatment, it is important to point out how, in this field of dentistry, there is a marked tendency to level and flatten this anatomical occlusal curve, as proposed by Andrews. If in orthodontics there is a standardized levelling of the curve of Spee, in the prosthetic and restorative field, the management of the curve of Spee requires greater attention and often even an individualized approach. The purpose of this study is to investigate what the levelling of the antero-posterior occlusal curve entails in terms of masticatory effectiveness and harmony. From the results obtained, it can be seen that in order to optimize the harmony of the stomatognathic apparatus, the curve of Spee is a parameter that requires individual attention: modifying it through standardized levelling has inevitable consequences.

Research paper thumbnail of Non-extraction orthodontic treatment for severe dental crowding using miniscrew-assisted rapid maxillary expansion

PubMed, Nov 1, 2022

Malocclusion is caused by an incorrect relationship between the teeth and jaws, which leads to an... more Malocclusion is caused by an incorrect relationship between the teeth and jaws, which leads to an abnormal variation of normal occlusion. Crowding is an increasingly common type of malocclusion caused by a discrepancy in tooth-jaw size that leads to twisted and misaligned teeth. Two methods to treat this malalignment are tooth material reduction and arch width expansion. Of these two treatment options, the latter is preferred because it enables orthodontists to avoid extractions and increase the dental arch perimeter by widening the jaws; this resolves crowding and accommodates existing teeth. This case report describes a unique approach in the treatment of a patient with severe crowding by an orthopaedic widening of the dental arches using a skeletally anchored rapid palatal expander. Under favorable circumstances, this approach can serve as a robust method to treat patients with severe crowding and may be used as an alternative to extraction.

Research paper thumbnail of AGPs and orthodontics

British Dental Journal, Aug 1, 2020

Research paper thumbnail of Growth differentiation factor-15 as predictor of periodontal treatment effects in patients with periodontitis: a randomized-controlled clinical trial

Research Square (Research Square), Mar 13, 2023

Background: It has been shown that periodontal treatment could potentially decrease the risk of d... more Background: It has been shown that periodontal treatment could potentially decrease the risk of developing cardiovascular disease (CVD) and that growth differentiation factor 15 (GDF-15) is a valuable biomarker of early CVD risk. This study evaluated the e cacy of periodontal treatment on growth differentiation factor 15 (GDF-15) and related circulating systemic risk biomarkers such as glutathione peroxidase 1 (GPx-1), c-reactive protein (hs-CRP), and surfactant protein D (SP-D) and explored whether patients with high GDF-15 at baseline showed increased clinical bene ts with two non-surgical treatments protocols at 6-months follow-up. Methods: Patients with periodontitis were randomized to receive quadrant (Q-SRP, n=23) or full-mouth disinfection (FMD, n=23) protocols. Clinical and periodontal parameters were recorded in all enrolled patients. Serum concentrations of GDF-15, GPx-1, hs-CRP, and SP-D concentrations were assessed at baseline and 30, 90, and 180-days follow-up through enzyme-linked immunosorbent assay (ELISA) and nephelometric assay techniques. Results: Q-SRP was more effective than FMD in lowering periodontal parameters, and the mean proportions of GDF-15 (p=0.005), GPx-1 (p=0.025), hs-CRP (p<0.001), and SP-D (p=0.042) after 6 months of treatment. Periodontal parameters were signi cantly associated with concentrations of GDF-15, GPx-1, hs-CRP, and SP-D at 6-months follow-up. Furthermore, the ANOVA analysis revealed that Q-SRP signi cantly in uenced the upregulation of GPx-1 and on downregulation of GDF-15, and SP-D and substantially impacted the effectiveness of periodontal therapy at 6 months follow-up. Conclusion: The results evidenced that, in comparison with FMD, Q-SRP was more effective at reducing periodontal variables and positively impacting GDF-15, GPx-1, hs-CRP, and SP-D concentrations, although patients who exhibited higher GDF-15 and SP-D and lowered GPx-1 at baseline, more bene ted the effects of periodontal treatment at 6-month follow-up.

Research paper thumbnail of Patient consent

British Dental Journal, May 27, 2022

Research paper thumbnail of Canine trends in SE Asia

British Dental Journal, Mar 1, 2021

Research paper thumbnail of Flipped classrooms

British Dental Journal, May 13, 2022

Research paper thumbnail of Unaffected in Cambodia

British Dental Journal, Nov 13, 2020

Research paper thumbnail of Satisficing and bots

British Dental Journal, Jan 28, 2022

Research paper thumbnail of Rare non-syndromic bilateral maxillary and mandibular permanent canine agenesis

Authorea (Authorea), Mar 31, 2022

Research paper thumbnail of South East Asia

British Dental Journal, Apr 1, 2021

Research paper thumbnail of Biomolecular and Biochemical Aspects of the Oral Cavity

Molecules, Dec 8, 2022

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Research paper thumbnail of Dental Luting Cements: An Updated Comprehensive Review

Molecules, Feb 8, 2023

This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY

Research paper thumbnail of Channa Striata and Hyperbaric Oxygen Therapy Combination for Pressure Areas in Orthodontic Treatment

Pesquisa Brasileira em Odontopediatria e Clínica Integrada

To study the effect of using a combination of Channa Striata gel and hyperbaric oxygen therapy on... more To study the effect of using a combination of Channa Striata gel and hyperbaric oxygen therapy on pressure areas during orthodontic treatment. Material and Methods: The study was conducted using the ARRIVE Essential 10 guidelines. In this study, 35 3-4 months male guinea pigs (Cavia Cobaya) weighing 300-400 grams were used and divided into 5 groups (n=7). Decalcification was performed to dissolve the dental calcium and jawbone to cut the tissue properly. The decalcification was performed for 30 days. Then preparations were made with HE (Hematoxylin Eosin), observed using a microscope, and counted the number of osteoclasts and macrophages on a light microscope with 400 times magnification. The results of the preparations were analyzed using the SPSS program. Results: The Kruskal-Wallis test of macrophage cells and the ANOVA test of osteoclast cells showed significant results between all groups (p<0.05). Conclusion: The effect of hyperbaric oxygen therapy 2,4 ATA administered on days 8-14 and Channa Striata extract gel administered on days 3-14 can increase the number of macrophages in the periodontal ligament and osteoclasts in the alveolar bone in the pressure area during orthodontic tooth movement.

Research paper thumbnail of Measuring tooth size discrepancies using Bolton analysis: a comparative cross-sectional study among major ethnicity in Malaysia

BMC Oral Health

Background The Bolton analysis is one of the commonly used tooth size analysis or diagnostic tool... more Background The Bolton analysis is one of the commonly used tooth size analysis or diagnostic tools in deriving a treatment plan for orthodontic patients. Many studies have indicated and concluded that normal measurements for one group should not be considered normal for other ethnic groups. The aims and objectives of this study were to investigate the applicability of Bolton’s ratios in the orthodontic population of Malaysian main ethnics, Malay, Chinese, and Indians. Comparisons were made in terms of size and distribution of tooth size discrepancy in the Malaysian orthodontic population and the findings were converted in terms of millimeters. Methods Hundred fifty pre-orthodontic study casts comprised of 52 Malay, 54 Chinese, and 44 Indian patients were selected. Digital calipers (Fowler Pro-Max) linked to Hamilton Tooth Arch Software were used to measure the tooth width and ratios. Statistical analysis was carried out to test for gender differences (independent t-test), to identif...

Research paper thumbnail of Complications associated with the surgical removal of non-syndromic supernumerary premolar tooth buds in the mandible

Journal of Surgical Case Reports

Hyperdontia involving the premolar teeth can be single or multiple or even related to a syndrome.... more Hyperdontia involving the premolar teeth can be single or multiple or even related to a syndrome. These are frequently encountered in permanent dentition, but their occurrence has ranged between 0.09 and 0.64% in the general population. These are commonly found between the permanent canines and first premolars but rarely between the first and second premolars. These are usually eumorphic and can be easily identified as they follow the conventional tooth morphology. These are usually asymptomatic and not easily palpable unless they are very close to eruption. A lingual approach is preferred during their removal over the buccal method as it poses less risk of root trauma. In this case, bilateral accessory premolar tooth buds were present between the first and second premolars. Since the patient was undergoing orthodontic treatment, she was advised to remove these accessory teeth. For their removal, a Neumann flap with a buccal approach was used, which led to fracturing the root apex o...

Research paper thumbnail of Interdisciplinary orthodontics-implants management of a challenging hypodontia case complicated by a class II division 2, bimaxillary retroclination

International Orthodontics

Introduction &gt; The case in thisstudy had moderate hypodontia, with both lower lateral inci... more Introduction &gt; The case in thisstudy had moderate hypodontia, with both lower lateral incisors and the lower-left second premolar missing. A Class II division 2 relationship with severe crowding in the upper arch and a traumatic deep bite over a skeletal I base complicated the occlusion. Materials and methods &gt; The plan was to extract the upper first premolars to relieve upper arch crowding and the lower-left impacted second premolar to preserve the bilateral class I molar relationship. A class I occlusal relationship was achieved through space opening in the lower lateral incisors region and space closure in the upper and lower premolars regions. Results &gt; The use of orthodontic screws for bite opening and anterior segment retraction, in conjunction with bi-metric slot size selection in bracket prescription, was effective in controlling incisor inclination and interincisal angle. The use of an implant fixture before beginning the finishing stage allowed for a reduction in total treatment time and facilitated the provision of the final prosthesis before debonding the case. As a result, the patient was able to receive a satisfactory occlusion on the day of debonding. Conclusion &gt; This case of moderate hypodontia was successfully resolved by combining space closure and space opening effectively. To solve the arch problems in such Class II division 2 cases with severe crowding, extractions were required. To complete the case, this was combined with intrusive and retractive mechanics. In hypodontia cases, implants are an excellent choice for both aesthetics and functional restoration.

Research paper thumbnail of The Evaluation of Clinical Signs and Symptoms of Malignant Tumors Involving the Maxillary Sinus: Recommendation of an Examination Sieve and Risk Alarm Score

Healthcare

This observational study was conducted to evaluate the clinical signs and symptoms of maxillary s... more This observational study was conducted to evaluate the clinical signs and symptoms of maxillary sinus tumors and to propose a clinical examination sieve and a unique risk alarm score to be used for timely patient referral and vigilance. The study consisted of 70 patients between 20 to 82 years of age from both sexes. The clinical information gained was collected from the upper dentoalveolar segment, orbit, and nasal sites. Regarding the early clinical sign and symptoms of patients, nasal obstruction was found in 67 patients (95.7%), facial swelling in 69 patients (98.6%), paresthesia in 41 patients (58.6%), and epistaxis in 50 patients (71.4%). Furthermore, in terms of the late signs and symptoms, a palpable mass in buccal sulcus was observed in 65 (92.9%) of the patients, lymphadenopathy in 24 (34.3%), paresthesia in 38 (54.3%), and diplopia in 22 (31.4%). Furthermore, general sign and symptoms like exophthalmos was present in 35 patients (50%), anosmia was observed in 37 patients ...

Research paper thumbnail of 3D Bitemark Analysis in Forensic Odontology Utilizing a Smartphone Camera and Open-Source Monoscopic Photogrammetry Surface Scanning

Brazilian Research in Pediatric Dentistry and Integrated Clinic, 2023

Research paper thumbnail of Variation in Location of the Distobuccal Root Canal in a permanent Maxillary Second Molar: A Case Report and Literature Review

This case report describes the unusual location of the distobuccal root canal in a maxillary seco... more This case report describes the unusual location of the distobuccal root canal in a maxillary second molar with root fusion. On access opening, three distinct root canal orifices, the mesiobuccal canal, palatal canal, and a third orifice closer to the palatal canal, were seen, giving an illusion of an additional palatal canal. An attempt was made to search for the distobuccal canal in its usual position, leading to the gouging of the pulp chamber floor. An intra-operative limited field of view cone-beam computed tomography (CBCT) revealed the root orifice adjacent to the palatal canal was the distobuccal canal. CBCT also revealed fusion of both the buccal and palatal roots in the root's coronal and middle third region, but they were not fused apically.