• J Endod. 2019 Apr;45(4):453-458. doi: 10.1016/j.joen.2018.12.010. Epub 2019 Feb 13. Radiographic Indications of Vertucci Type V Configuration in the Distal Root of Mandibular Molars: A Case Series. Jeong JW1, Zegar Z2, Liu RY2, Makins SR2. Abstract Knowledge of the prevalent root canal anatomy and potential variations is necessary before the initiation of endodontic treatment. The purpose of this study was to aid in the detection and treatment of the Vertucci type V canal configuration when present in the distal root of the mandibular molars. This case series presents 3 radiographic indications of a type V configuration in the distal roots of the mandibular molars as revealed on conventional periapical radiographs: a "ghost" apex, a fast break canal, and eccentric canal tracing. Nonsurgical endodontic treatment was performed for 5 mandibular molars with the type V distal root canal. Four cases showed posttreatment resolution of symptoms and return of normal function. One case was classified as "failed" because of persistent symptoms and clinical signs. The tooth was surgically treated and subsequently healed. These case reports show the importance of visualizing and managing the anatomic variations of the canal system in distal roots of mandibular molars and incorporating these capabilities into clinical practice to enhance the occurrence of a successful outcome. Additionally, clinical guidelines are provided that can help clinicians overcome the challenges in diagnosing and treating such complex cases. Copyright © 2018 American Association of Endodontists. Published by Elsevier Inc. All rights reserved. (04/2019)