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 Table of Contents  
Year : 2020  |  Volume : 1  |  Issue : 1  |  Page : 16-18

Endodontic management of mandibular second premolar with three canals

1 Department of Conservative and Endodontics, Pacific Dental College, Udaipur, Rajasthan, India
2 Department of Conservative and Endodontics, Pacific Dental College and Hospital, Udaipur, Rajasthan, India

Date of Submission05-Dec-2020
Date of Acceptance17-Dec-2020
Date of Web Publication31-Dec-2020

Correspondence Address:
Prashant Purandhar Shetty
Department of Conservative and Endodontics, Pacific Dental College and Hospital, Udaipur - 313 024, Rajasthan
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jpcdoh.jpcdoh_3_20

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Knowledge of root canal morphology has been a complex and utmost important issue regarding the planning and implementation of root canal therapy. In addition to having adequate knowledge on periapical radiographs from different angles, careful examination of pulp chamber floor and the use of technological advances are also salient factors that contribute to the diagnosis of additional roots and canals. The occurrence of three canals with three separate (Type V, Vertucci) foramina in mandibular premolars is very rare. This article reports and discusses the treatment for an atypical occurrence of three canals with three separate foramina in the mandibular second premolar.

Keywords: Foramina, mandibular premolar, radiographs

How to cite this article:
Jain P, Jain S, Jain D, Shetty PP. Endodontic management of mandibular second premolar with three canals. J Prim Care Dent Oral Health 2020;1:16-8

How to cite this URL:
Jain P, Jain S, Jain D, Shetty PP. Endodontic management of mandibular second premolar with three canals. J Prim Care Dent Oral Health [serial online] 2020 [cited 2022 Jun 29];1:16-8. Available from: http://www.jpcdoh.org/text.asp?2020/1/1/16/305893

  Introduction Top

Triumph in the endodontic treatment requires an understanding of root canal anatomy and morphology. To achieve endodontic success, the entire root canal system must be completely cleaned, disinfected, and obturated. The presence of root canal variation increases the difficulty of the treatment.[1] The clinician must have a thorough knowledge of normal anatomy and common variations from the norm. The clinician must also be prepared to diagnose those teeth that tend to vary greatly from the norm, for example, mandibular premolars.[2] Diligent attention is essential to minimize failure and it is also the need for subsequent endodontic retreatment. Mandibular premolars have known for aberrant anatomy. According to different studies conducted over the years, mandibular premolars have been reported a fairly high percentage of these teeth to have more than one canal.[3],[4],[5],[6] The majority of mandibular second premolar teeth have a single canal, but approximately 9.0% have two or more canals.[7] A single apical foramen might be found in mandibular second premolar teeth in >9 out of 10 cases, but two or more foramina might occur approximately 8.2% of the time.[7] The purpose of this case report is to present successful endodontic management of permanent mandibular second premolar having three canals with Vertucci's Type v configuration.

  Case Report Top

A 62-year-old male patient with no underlying disease reported to the department of conservative dentistry and endodontics with a chief complaint of pain on biting in relation to the lower right back tooth region for 15 days. Clinical examination found acceptable oral hygiene with normal periodontal status and tenderness on percussion and palpation on teeth #44 and #45. The teeth showed no mobility and sharp pain upon thermal stimuli (electric pulp test) irt #44 and #45. Diagnostic Radiographic examination showed periapical radiolucency irt#44 and #45 [Figure 1]. Based on the clinical and radiographic findings, the teeth were diagnosed with symptomatic irreversible pulpitis with symptomatic apical periodontitis. Root canal therapy (RCT) was proposed for #44 and #45. Informed consent was taken.
Figure 1: Preoperative orthopantomography showing teeth #44 and #45

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Teeth #44 and #45 were prepared for nonsurgical endodontic therapy. After administration of local anesthesia, rubber dam isolation was done, and traditional endodontic access opening was made. After removing pulp tissue in relation to tooth #44 revealed two orifices, namely, buccal and lingual, while tooth #45 revealed three separated canal orifices, which were mesiobuccal, distobuccal, and lingual. The orifices of the mesiobuccal, distobuccal, and lingual were located at the same level [Figure 2].
Figure 2: Access opening showing three orifices in relation to #45 and two orifices in relation to #44

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The canal scouting was done with the help of the # 6k file and was initially instrumented with #10 K-file (Dentsply Maillefer). The working length of each canal was estimated using an electronic apex locator (Root ZX; Morita, Tokyo, Japan) and then confirmed with the help of a radiograph [Figure 3]. Biomechanical preparation was done under irrigation with 2.5% sodium hypochlorite and 17% ethylenediaminetetraacetic acid. Cleaning and shaping of the canals were done using Hyflex CM System. Corresponding master cones were selected, and fit was confirmed with the radiograph [Figure 4]. The canals were obturated with AH plus resin sealer (Dentsply Maillefer, Ballaigues, Switzerland) and corresponding gutta-percha points using the lateral condensation technique. The cavity was then restored with posterior composite filling [Figure 5]. The nonsurgical RCT was completed in relation to tooth #44 and #45.
Figure 3: Working length IOPAR in relation to #44 and #45

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Figure 4: Master cone IOPAR in relation to #44 and #45

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Figure 5: Postobturation IOPAR in relation to #44 and #45

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  Discussion Top

Mandibular premolars usually have a single root and a single canal. The solitary root is usually oval in cross-section containing an oval cross-section canal. Canal configurations in mandibular premolars may vary significantly with respect to ethnicity, race, and gender.[8] A great deal of variation can be seen in the mandibular second premolar. The compound nature of the root and root canal morphology of the mandibular second premolar has been disparaged. Two or more canals were found in the mandibular second premolar tooth in 5.2%, 4.4%, and 2.5% of the patients, respectively.[9] Mandibular bicuspids may be one of the most difficult teeth in the mouth to treat. This is primarily due to the variations in internal morphology of the pulp cavity, considering the number of root canals, apical deltas, and lateral canals. In addition, the access cavities are relatively small, thereby the visibility is reduced. The prevalence of three root canals with three orifices was reported to be 0.4% by El Deeb in 1982. The occurrence of three canals in mandibular second premolars has been reported as 0%–0.4%. The occurrence of three canals with three separate roots with three separate foramina (Type V, Vertucci) is very rare.[10]

Following diagnostic information and various techniques might help clinicians detect additional roots and canals.

  1. A second radiograph from 15° to 20° 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[9]
  2. Narrowing of the canal system on parallel radiograph suggests canal system multiplicity[11]
  3. 40° mesial angulation of the X-ray beam to identify extra canal[12]
  4. Use of magnification to improve the clinicians' ability to visualize and access canals
  5. Use of three-dimensional imaging methods micro-computed tomography (CT) and cone-beam CT (CBCT).

A desk research revealed that the human mandibular second premolar has an extremely anomalous root and root canal morphology. Nevertheless, the incidence of both multiple roots and multiple canals in the mandibular second premolar is lower than that found in the mandibular first premolar.[7]

  Conclusion Top

Successful and foreseeable endodontic treatment requires a thorough knowledge of biology, physiology, and root canal anatomy. It also requires proper instruments and thorough knowledge to use these instruments effectively. It is of utmost importance to use all the available diagnostic tools to find and treat the complete root canal system. Cautious interpretation of angled radiographs, good access preparation, proper inspection of pulpal floor, and a detailed examination of the interior of the tooth perfectly under magnification and CBCT are important prerequisites.


Advanced diagnostic radiographic techniques can be used, such as CBCT and micro CT and Operating microscope for significantly higher magnification.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Zhang M, Xie J, Wang Yh. et al. Mandibular first premolar with five root canals: a case report. BMC Oral Health 2020;253:20. https://doi.org/10.1186/s12903-020-01241-0.  Back to cited text no. 1
Nallapati S. Three canal mandibular first and second premolars: a treatment approach. J Endod 2005;31:474-6.  Back to cited text no. 2
Barrett MT. The internal anatomy of teeth with special reference to the pulp and its branches. Dental Cosmos 1925;67:581-92.  Back to cited text no. 3
Amos ER. Incidence of bifurcated root canals in mandibular bicuspids. J Am Dent Assoc 1955;50:70-1.  Back to cited text no. 4
England MC Jr., Hartwell GR, Lance JR. Detection and treatmen tof multiple canals in mandibular premolars. J Endod 1991;17:174-8.  Back to cited text no. 5
Baisden MF, Kulild JC, Weller RN. Root canal configuration of the mandibular first premolar. J Endod 1992;18:505-8.  Back to cited text no. 6
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. 7
Kottoor J, Albuquerque D, Velmurugan N, Kuruvilla J. Root anatomy and root canal configuration of human permanent mandibular premolars: a systematic review. Anat Res Int 2013;2013:254250.  Back to cited text no. 8
Cleghorn BM, Christie WH, Dong CC. The root and root canal morphology of the human mandibular second premolar: a literature review. J Endod 2007;33:1031-7.  Back to cited text no. 9
Desai N, Shiraguppi VL, Srinidhi SR, Jaggi S. Mandibular second premolar with three canals: Re-treatment of a case with unusual root canal anatomy. J Int Clin Dent Res Organ 2011;3:68-70.  Back to cited text no. 10
  [Full text]  
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. 11
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;88:719-22.  Back to cited text no. 12


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


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