Methodological Approach to the Endodontic Treatment of First Premolars with Three Root Canals: Two Case Reports
Rémy Balthazard, Pascale Corne, Marin Vincent, Eric Mortier
Additional root canals, Mandibular first premolar, Maxillary first premolar, Root canal treatment
Citation Information :
Balthazard R, Corne P, Vincent M, Mortier E. Methodological Approach to the Endodontic Treatment of First Premolars with Three Root Canals: Two Case Reports. J Contemp Dent Pract 2019; 20 (2):263-269.
Aim: The aim of this article was to promote a methodology in the endodontic management of complex premolars with multiple root canals
Background: The success of endodontic treatment depends on a meticulous clinical and radiographic analysis, the creation of a suitable access cavity and chemical and mechanical preparation, followed by three-dimensional filling of the entire root canal system. Consequently, it is essential to look for the presence of additional root canals to prevent endodontic treatment failure
Case description: Two cases are presented. The first case concerned a 50-year-old male patient of North African origin who consulted in the context of a global prosthetic restoration including endodontic treatment of the maxillary left first premolar (tooth no. 24).
The second case concerned a 29-year-old male patient of North African origin who was referred to us by his primary care practitioner in an urgent context of pain and infection present for two weeks (tooth no. 44).
In both cases, it was the in-depth radiographic analysis, combined with manual exploration under the surgical microscope, that led to the relatively rare identification of a third root canal. Shaping, disinfection and three-dimensional filling of the entire root canal system were then performed in accordance with widely validated protocols.
Conclusion: The maxillary and mandibular premolars, due to their highly variable root canal system configuration and a number of root canals and roots, appear to be teeth for which treatment is potentially complex.
The acuteness of digital-tactile sense and the advent of 3D imaging and optical aids optimize the treatment of all the root canals of a tooth
Clinical significance: These case reports demonstrate the importance of clinical and radiographic inspections to guide practitioners in the search for additional root canals in premolars and promote a methodological approach.
Sieraski SM, Taylor GN, Kohn RA. Identification and endodontic management of three-canalled maxillary premolars. J Endod. 1989 Jan;15(1):29-32.
Ordinola-Zapata R, Bramante CM, Villas-Boas MH, Cavenago BC, Duarte MH, Versiani MA. Morphologic micro-computed tomography analysis of mandibular premolars with three root canals. J Endod. 2013 Sep;39(9):1130-1135.
Slowey RR. Root canal anatomy. Road map to successful endodontics. Dent Clin North Am. 1979 Oct;23(4):555-573.
Weng XL, Yu SB, Zhao SL, Wang HG, Mu T, Tang RY, Zhou XD. Root canal morphology of permanent maxillary teeth in the Han nationality in Chinese Guanzhong area: a new modified root canal staining technique. J Endod. 2009 May;35(5): 651-656.
Cleghorn BM, Christie WH, Dong CC. The root and root canal morphology of the human mandibular first premolar: a literature review. J Endod. 2007 Sep;33(9):509-516.
Kartal N, Ozçelik B, Cimilli H. Root canal morphology of maxillary premolars. J Endod. 1998 Jun;24(6):417-419.
Ahmad IA, Alenezi MA. Root and Root Canal Morphology of Maxillary First Premolars: A Literature Review and Clinical Considerations. J Endod. 2016 Jun;42(6):861-872.
Ok E, Altunsoy M, Nur BG, Aglarci OS, Çolak M, Güngör E. A cone-beam computed tomography study of root canal morphology of maxillary and mandibular premolars in a Turkish population. Acta Odontol Scand. 2014 Nov;72(8):701-706.
Trope M, Elfenbein L, Trondstad L. Mandibular premolars with more than one root canal in different race groups. J Endod. 1986 Aug;12(8):343-345.
Vertucci FJ. Root canal morphology and its relationship to endodontic procedures. Endod Topics. 2005;10:3-29.
Cantatore G, Berutti E, Castellucci A. Missed anatomy: frequency and clinical impact. Endod Topics. 2006;15:3-31.
Shalavi S, Mohammadi Z, Abdolrazzaghi M. Root canal treatment of maxillary and mandibular three-rooted premolars: a case report. Iran Endod J. 2012 Summer;7(3):161-164.
Dadresanfar B, Khalilak Z, Shahmirzadi S. Endodontic treatment of a maxillary first premolar with type IV buccal root canal: A case report. Iran Endod J. 2009 Winter;4(1):35-37.
Hoen MM, Pink FE. Contemporary endodontic retreatments: An analysis based on clinical treatment findings. J Endod. 2002 Dec;28(12):834-836.
Patel S, Dawood A, Whaites E, Pitt Ford T. New dimensions in endodontic imaging: part 1- conventional and alternative radiographic systems. Int Endod J. 2009 Jun;42(6):447-462.
Martínez-Lozano MA, Forner-Navarro L, Sánchez-Cortés JL. Analysis of radiologic factors in determining premolar root canal systems. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999 Dec;88(6):719-722.
Balakasireddy K, Pavan Kumar K, Gijo J, Gagan C. Cone Beam Computed Tomography Assisted Endodontic Management of a Rare Case of Mandibular First Premolar with Three Roots. J Int Oral Health. 2015 Jun;7(6):107-109.
Yoshioka T, Villegas JC, Kobayashi C, Suda H. Radiographic evaluation of root canal multiplicity in mandibular first premolars. J Endod. 2004 Feb;30(2):73-74.
Soares JA, Leornado RT. Root canal treatment of three rooted maxillary first and second premolars: A case report. Int Endod J. 2003 Oct;36(10):705-710.
Matherne RP, Angelopoulos C, Kulild JC, Tira D. Use of conebeam computed tomography to identify root canal systems in vitro. J Endod. 2008 Jan;34(1):87-89.
Krapež J, Fidler A. Location and dimensions of access cavity in permanent incisors, canines, and premolars. J Conserv Dent. 2013 Sep;16(5):404-407.
Maibaum W. Endodontic treatment of a” ridiculous” maxillary premolar: a case report. General Dent. 1989;37(4):340-341.
Balleri P, Gesi A, Ferrari M. Primer premolar superior com tresraices. Endod Pract. 1997;3:13-15.
England MC Jr, Hartwell GR, Lance JR. Detection and treatment of multiple canals in mandibular premolars. J Endod. 1991 Apr;17(4):174-178.