Mandibular premolars are known to have numerous anatomic variations of their roots and root canals, which are a challenge to treat endodontically. The paper reviews literature to detail the various clinically relevant anatomic considerations with detailed techniques and methods to successfully manage these anomalies. An emphasis and detailed description of every step of treatment including preoperative diagnosis, intraoperative identification and management, and surgical endodontic considerations for the successful management of these complex cases have been included.

The main goal of vital pulp therapy is to preserve and maintain pulpal health in teeth that have been exposed to caries, trauma, and restorative procedures. This type of endodontic treatment is very important in young permanent teeth that have not reached their complete length and exhibit thin-walled roots and wide open apices. The developments in knowledge of pulpal physiology and immunology, beside to newly introduced dental materials, have changed the treatment approaches for teeth with involved pulps. This report describes a case of a young patient in whom maxillary right central incisor suffered crown fractures because of a traumatic accident. Pulpotomy with MTA were performed in order to achieve apexogenesis and the tooth was restored with a glass ionomer cement and composite resin. The patient was reviewed over 4years.

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