Root canal treatment of a mandibular second premolar with three separate root canals

Abstract

Mandibular premolars show a wide variety of root canal anatomy. Especially, the occurrence of three canals with three separate foramina in mandibular second premolars is very rare. This case report describes the root canal treatment of an unusual morphological configuration of the root canal system and supplements previous reports of the existence of such configuration in mandibular second premolar. Ⅰ. IntroductionSuccessful root canal treatment requires an understanding of root canal morphology and anatomy. Accurate diagnosis of root canal morphology and anatomy is essential for thorough shaping and cleaning of the entire root canal system and consequent successful root canal treatment.1) Mandibular premolars show a wide variety of root canal anatomy. 2)There seems to be a racial predisposition for the presence of two or more canals in maxillary and mandibular premolars, as well as their bilateral occurrence.2,3) Especially, the occurrence of three canals with three separate foramina in mandibular premolars is very rare. Vertucci 4) and Zillich et al 5) reported the occurrence of three canals in mandibular first premolars at 0.5% and 0.4% respectively. Their studies in second premolars showed these percentages at 0.0% and 0.4%, respectively. To our knowledge, however, there is rare case report about treatment of mandibular second premolar with three separate canals divided at the apical level of the root whereas most previous reports showed that the orifices were found in the mid root section.6) The present case report describes the root canal treatment of a mandibular second premolar having three independent root canals with separate foramina. Ⅱ. Case ReportA 27-year-old man with a noncontributory medical history was referred because of occasionally slight spontaneous pain in the mandibular left second premolar. The tooth was diagnosed as irreversible pulpitis and initiated to have root canal treatment by general dentist 2 days ago, but could not negotiate all of the root canals. After this treatment, the initial acute symptom had been relieved, but the tooth was still symptomatic and tender to percussion. A radiographic image of the tooth showed an unusual anatomy of these teeth (Figure 1). According to clinical and radiographic examination, a diagnosis of pulp necrosis with apical periodontitis was made.The tooth was anaesthetized, isolated with rubber dam and temporary filling was removed. The apical third was explored to locate the canal orifices using ABSTRACT *Corresponding