Table of Contents  
CASE REPORT
Year : 2014  |  Volume : 6  |  Issue : 1  |  Page : 73-75

Endodontic management of mandibular second premolar with three roots and three root canals: A case report


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 Publication15-May-2014

Correspondence Address:
Nidhi Shrivastava
18/84 Tilak Nagar, Baghambari Road, Allapur, Allahabad - 211 006, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0975-8844.132592

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  Abstract 

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 Top


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. [1],[2] 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. [3] The incidence of the number of roots and the number of canals reported in anatomical studies varies greatly in the literature. [4],[5] 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. [6] 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 Top


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].
Figure 1: Preoperative radiograph

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Figure 2: Working length radiograph

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Figure 3: Obturation radiograph

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  Discussion Top


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. [5]

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%). [7]

Published studies [7],[8],[9],[10],[11] 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. [12] Martinez-Lozano et al. have suggested a 40-degree mesial angulation of the x-ray beam to identify additional canals. [13]

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 Top


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 Top

1.Vertucci FJ. Root canal morphology and its relationship to endodontic procedures. Endod Topics 2005;10:03-29  Back to cited text no. 1
    
2.Aguiar C, Mendes D, Camara A, Figueiredo J. Endodontic treatment of a mandibular second premolar with three root canals. J Contemp Dent Tract 2010;11:78-84.  Back to cited text no. 2
    
3.Slowey RR. Root canal anatomy: Road map to successful endodontics. Dent Clin North Am 1979;23:555-73.  Back to cited text no. 3
[PUBMED]    
4.Trope M, Elfenbein L, Tronstad L. Mandibular premolars with more than one root canal in different race groups. J Endod 1986;12:343-5.  Back to cited text no. 4
[PUBMED]    
5.Zillich R, Dowson J. Root canal morphology of mandibular first and second premolars. Oral Surg Oral Med Oral Pathol Oral Radiol 1973;36:738-44.  Back to cited text no. 5
    
6.Lin Z, Ling J, Jhugroo A. Mandibular first and second premolars with three canals. Internet J Dent Sci 2006;4:1.  Back to cited text no. 6
    
7.Vertucci FJ. Root canal anatomy of human permanent teeth. Oral Surg Oral Med Oral Pathol 1984;58:589-99.  Back to cited text no. 7
[PUBMED]    
8.Cleghorn BM, Christie WH, Dong CC. The root and root canal morphology of the human mandibular first premolar: A literature review. J Endod 2007;33:509-16.  Back to cited text no. 8
    
9.Calikan M, Pehlivan Y, Septeciolu F, Turkun M, Tuncer SS. Root canal morphology of human permanent teeth in a Turkish population. J Endod 1995;21:200-4.  Back to cited text no. 9
    
10.Sert S, Aslanalp V, Tanalp J. Investigation of the root canal configurations of mandibular permanent teeth in the Turkish population. Int Endod J 2004;37:494-9.  Back to cited text no. 10
    
11.Iyer VH, Indira R, Ramachandran S, Srinivasan MR. Anatomical variations of mandibular premolars in Chennai population. Indian J Dent Res 2006;17:7-10.  Back to cited text no. 11
[PUBMED]  Medknow Journal  
12.Yoshioka T, Villegas JC, Kobayashi C, Suda H. Radiographic evaluation of root canal multiplicity in mandibular first premolars. J Endod 2004;30:73-4.  Back to cited text no. 12
    
13.Martinez-lozano MA, Forner-Navarro L, Sanchez-Cortes JL. Analysis of radiologic factors in determining premolar root canal systems. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;88:719-22.  Back to cited text no. 13
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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Abstract
Introduction
Case report
Discussion
Conclusion
Introduction
Case report
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