|Year : 2014 | Volume
| Issue : 1 | Page : 73-75
Endodontic management of mandibular second premolar with three roots and three root canals: A case report
Nidhi Shrivastava1, Marisha Bhandari2
1 MDS, Conservative Dentistry and Endodontics, Private Practitioner, Allahabad, Uttar Pradesh, India
2 Lecturer, Departmentof Conservative Dentistry and Endodontics, Himachal Institute of Dental Sciences, Paonta Sahib, Himachal Pradesh, India
|Date of Web Publication||15-May-2014|
18/84 Tilak Nagar, Baghambari Road, Allapur, Allahabad - 211 006, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
High level of success in endodontic treatment requires an understanding of root canal anatomy and morphology. The clinician must be prepared to identify those teeth that tend to vary generally from norm. Thorough debridement and obturation of such teeth can be challenging and failing to do so can lead to treatment failure. Mandibular premolars have earned the reputation for having aberrant anatomy. However, the occurrence of three separate canals with three separate foramina in mandibular premolars is very rare. The incidence of three canals is as high as 23% in mandibular first premolars, whereas in second premolars incidence is as low as 0.4%. Three rooted mandibular second premolar is reported to be 0.2%. This case report describes endodontic management of one such tooth with unusual morphological variations in canal anatomy of mandibular second premolar.
Keywords: Aberrant anatomy, mandibular premolar, morphologic variation, three root canals
|How to cite this article:|
Shrivastava N, Bhandari M. Endodontic management of mandibular second premolar with three roots and three root canals: A case report. J Orofac Sci 2014;6:73-5
|How to cite this URL:|
Shrivastava N, Bhandari M. Endodontic management of mandibular second premolar with three roots and three root canals: A case report. J Orofac Sci [serial online] 2014 [cited 2019 Dec 7];6:73-5. Available from: http://www.jofs.in/text.asp?2014/6/1/73/132592
| Introduction|| |
The main objectives of root canal treatment are thorough cleaning and shaping of all pulp spaces and its complete obturation. Knowledge of both basic root and root canal morphology and its possible variations is necessary and is important to achieve successful root canal therapy. The presence of an untreated or missed canal may be a reason to failure of endodontic treatment. , Most of the time root canals are left untreated because the clinicians fail to identify their presence particularly in teeth that have anatomical variation. Mandibular premolars are most difficult teeth to treat, probably because of the aberrations in their canal morphology.  The incidence of the number of roots and the number of canals reported in anatomical studies varies greatly in the literature. , Mandibular premolars may have highly variable and extremely complex root canal morphology. It has been observed that 5.3% of mandibular second premolars examined had two canals with two foramen and 44% had two canals with one foramen and only 0.4-5% showed three canal and three foramen configuration.  The purpose of this article is to report and discuss the diagnosis and treatment recommendations of a rare occurrence of three roots and three canal mandibular second premolar.
| Case report|| |
A 45-year-old patient presented with severe pain in the lower left mandible. The diagnostic radiograph showed carious 35 and 37 and obturated 36 [Figure 1]. The premolar was carious exposed and the tooth was symptomatic and severely tender on percussion. The diagnosis was acute irreversible pulpitis with apical periodontitis in relation to the mandibular second premolar. On careful evaluation of the diagnostic radiograph, it was seen that in the mandibular premolar, three roots were present. Local anesthesia was administered and rubber dam was placed. Access was achieved using a round diamond bur. The two orifices were located one buccal and one lingual. One more orifice was found in close approximation with the lingual orifice. The working length was established radiographically for all the three canals [Figure 2]. Chemo mechanical preparation was performed using the ProTaper File system (Dentsply-Maillefer, Ballaigues, Switzerland) in a crown-down manner. A 5.25% solution of sodium hypochlorite and 17% EDTA was used alternatively as irrigants at every change of instrument. The apical preparation was done till the F2 file size process in both the canals and the canals were obturated with corresponding ProTaper cones. A postobturation radiograph was recorded [Figure 3].
| Discussion|| |
Mandibular second premolars with two root canals have been reported on several occasions. Although it might occur, the incidence of three separate canals is very rare. An incidence of 0.4% of mandibular second premolar with three root canals is reported. 
Two separate and distinct root canals were reported in 2.5% of mandibular second premolars by Vertucci, but he has not reported any case of mandibular second premolar with three root canals and the incidence of three roots is extremely rare (0.1%). 
Published studies ,,,, citing the anatomy and morphology of mandibular premolars report that approximately 98% of the teeth in these studies were single rooted. The incidence of two roots was 1.8%.Three roots when reported were found in 0.2% of the teeth studied. Four roots were rare and were found in less than 0.1% of the teeth studied.
The complex nature of the root and root canal morphology of the mandibular second premolar has been underestimated. The following clues from diagnostic information and techniques might help clinicians detect additional root(s) and canal(s). A second radiograph from 15-20 degrees from either mesial or distal from the horizontal long axis of the root is necessary to accurately diagnose the number of roots and canals in premolar teeth. Yoshioka et al. have indicated that sudden narrowing of the canal system on a parallel radiograph suggests canal system multiplicity.  Martinez-Lozano et al. have suggested a 40-degree mesial angulation of the x-ray beam to identify additional canals. 
Successful and predictable endodontic treatment requires knowledge of biology, physiology and root canal anatomy. It also requires proper instruments and the knowledge to use these instruments effectively. Teeth with extra roots and/or canals pose a particular challenge. Inability to identify and treat these additional root canals may cause treatment failures. Careful examination of preoperative radiographs can aid in locating additional canal or roots. Thus, root canal therapy of these teeth should be carried out by using x-rays from different angulations, efficient explorers, wider access openings, adequate illumination and, whenever possible, image magnification. Necessary precautions have to be taken during root canal therapy of these teeth and hence instrumentation of these canals was carried out using nickel titanium files, due to their flexibility, lesser risks of ledge formation and perforations.
| Conclusion|| |
The incidence of more than one root, more than one canal, and more than one foramen is less frequent in mandibular second premolar than first premolar. When performing root canal therapy, additional canals might be missed, leading to a greater failure rate, unless there is constant vigilance in locating two or more canals in the mandibular second premolar. This case has been reported to share our experience and increase the awareness of clinicians on aberrations in tooth morphology of mandibular premolar teeth for a more predictable treatment outcome.
| References|| |
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[Figure 1], [Figure 2], [Figure 3]