Diagnosis and root canal treatment in a mandibular premolar with three canals

Abstract

This paper presents a case report of a left mandibular second premolar with three canals and three different apical foramina. A 39-year-old male patient presented to our clinic with pain in the mandibular left second premolar. Initially, pain was caused by cold stimulus and later was spontaneously. The intraoral clinical examination revealed a fractured amalgam restoration with occlusal caries. Percussion and cold (Endo-Frost) tests were positive. The radiographic examination showed the presence of two roots. The probable diagnosis was an acute pulpitis. After access cavity, it was observed remaining roof of the pulp chamber and mild bleeding in the tooth lingual area, indicating the possible presence of a third canal. The endodontic treatment was completed in a single session using Root ZX apex locator and K3 NiTi rotary system with surgical diameter corresponding to a .02/45 file in the three canals and irrigation with 1% sodium hypochlorite. The canals were obtured with gutta-percha cones and Sealer 26 using the lateral condensation technique. After 1 year of follow-up, the tooth was asymptomatic and periapical repair was observed radiographically. Internal alterations should be considered during the endodontic treatment of mandibular second premolars. The correct diagnosis of these alterations by the analysis of preoperative radiographs can help the location of two or more canals, thereby avoiding root therapy failure.

Tratamento endodôntico de primeiro pré-molar inferior com três canais: relato de caso

“…Porém o diagnóstico pode ser auxiliado pela tomografia computadorizada e pela microscopia, além de uma análise detalhada dos aspectos anatômicos da câmara pulpar 10 . A análise tátil é essencial ao tratamento, com uma correta sondagem dos pavimentos da câmara pulpar utilizando-se limas de diâmetro reduzido ou sondas endodônticas retas de ponta bem afiada.…”

Mandibular Second Premolar with Three Roots: A Case Report

“…(3) The root and root canal morphology of the mandibular second premolar can be extremely complex and requires careful assessment. (3,5,6) Some of the root canal anatomic aberrations reported as cases in the literature include mandibular second premolars with three root canals, (7)(8)(9)(10)(11)(12)(13) four root canals, (14)(15)(16)(17)(18) four root canals, (19) three separate roots with taurodontism, (20) and C-type morphology. (6) The primary step in root canal treatment is to identify the internal morphology of the canal system.…”

Clinical features and endodontic treatment of two-rooted mandibular canines: Report of four cases

“…If the endodontic instrument is inclined too buccally or lingually and cannot be removed from the canal in an opposite direction, the eventual presence of two canals might be indicated [19]. Using augmentative equipment, such as magnifying loupes or an endodontic microscope is very helpful during the diagnosis of the canal system.…”