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(a) Preoperative intraoral periapical radiograph (straight angulation) (b) Preoperative intraoral periapical radiograph (mesial angulation) (c) Preoperative intraoral periapical radiograph (distal angulation)
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Mandibular premolars have earned the reputation for having aberrant anatomy. The literature is replete with reports of extra canals in mandibular first premolars, but reports about the incidence of extra roots in these teeth are quite rare. This paper attempts at explaining a rare case of successful endodontic management of a four-rooted mandibular...
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Introduction: The success of endodontic treatment is based on correct determination of the number of roots and root canals. Therefore, variants in root number and root canal number are a constant therapeutic challenge. The permanent mandibular first molar (PMFM) usually has a mesial root with two canals and a distal root with one or two canals, but...
Citations
... The initial observation of these cases with respect to pulp chamber floor revealed multiple orifices which were then confirmed by the radiographic examination (24,28). However, in cases where the patients do not report any complain with the aberrant morphological teeth, they accidently get diagnosed during the routine radiographic examination or due to complain of the adjacent teeth (33). ...
... The studies also reported cases with a single root but presence of two and three canals (29,34,35). Interestingly, there was also a case reported by Vaghela et al. having four roots and four canals (mesiobuccal, distobuccal, mesiolingual, distolingual) (33). The presence of 2 roots with 2 canals, 4 canals and 5 canals were evident in few studies (16)(17)(18)22) while four of the studies also presented 1 root with 3 canals and 5 canals (16,19,20,26). ...
... In the present case report and the literature review conducted, intra-canal irrigation in all the patients was performed by NaOCl of varying concentrations with 2.5%, 3%, 5% and 5.25% along with saline to flush the canal. The use of 17% EDTA for removing the smear layer was reported with 12 cases (14,16,17,19,21,22,24,27,28,30,32,33). Few studies have also reported the use of 15% EDTA, 10% citric acid, and 0.2% chlorhexidine as an intracanal irrigant (11)(12)(13)20). ...
Background: Root canal morphology and internal anatomy shows a great variation across all the teeth. Mandibular premolars possess a great challenge to the clinicians due to its aberrant root morphology. The presence of bacteria and other microbes is the main factor in endodontic failure in missed canals. It is very essential to perform a complete debridement of the root canals including the accessory canals for a successful outcome attained using irrigants, agitation techniques and intra-canal medicaments. This article aims to provide a detailed review about the etiology, prevalence, clinical features, radiographic features & techniques, magnification, treatment choices and difficulties encountered in managing aberrant anatomies in mandibular premolar along with the presentation of a case report. Case Description: A 19-year-old female patient presented to the department with a chief complaint of sharp shooting, lingering and continuous pain in the lower right back region of the jaw since 1 month. On digital radiographic investigation, an aberrant root canal anatomy was observed with deep disto-occlusal caries with mandibular right second premolar for which a non-surgical root canal therapy was performed using dental operating microscope (DOM) and advanced irrigation activation system. Besides, PubMed/ inclusion and exclusion criteria, 25 articles were included. Conclusions: The case report and literature review come to the conclusion that cases with aberrant mandibular premolars can be successfully treated with conventional root canal therapy, good diagnostic tools, and, if necessary, surgical intervention. Our case illustrates how anatomical variations could make endodontic treatment more challenging. With an emphasis on access modifications and radiographic interpretations, the application of the DOM and essential adjustments to the standard clinical procedures and more novel diagnostic methods for difficult root canal morphologies will be essential in the future of endodontics to successfully manage such complex anatomies.
... Several anatomic variations have been reported for both mandibular premolars, demonstrating their susceptibility to complex RCA 5 , and RCT of these teeth is considered one of the more time-and effort-intensive treatments. 6,7 Different methods have been used to detect and evaluate RCA, such as 2D radiographs, clearing teeth, cone beam computed tomography (CBCT) or micro-computed tomography (µCT).8-12 CBCT has been reported to show reliable and accurate one of the more time-and effort-intensive treatments. ...
... CBCT has been reported to show reliable and accurate one of the more time-and effort-intensive treatments. 6,7 Different methods have been used to detect and evaluate RCA, such as 2D radiographs, clearing teeth, cone beam computed tomography (CBCT) or microcomputed tomography (µCT). [8][9][10][11][12] CBCT has been reported to show reliable and accurate information about RCA. ...
Objectives: To investigate the root canal morphology of permanent mandibular premolars using cone-beam computed tomography (CBCT) in the selected population and to review previous studies regarding other selected Turkish subpopulations. Materials and Methods: The sample for this retrospective study included 1048 CBCT images of 672 females and 376 males representing 1613 mandibular first and 1461 second premolars. Pubmed and Google Scholar were used to search previous literature with selected keywords. Results: The incidence of single root in mandibular first and second premolars was 99.75% and 99.38%, respectively. Complex root canal anatomy was evident in the first premolars compared to second premolars and in males than females (p<0.05). Eight studies have previously evaluated the root canal anatomy of mandibular premolars of other Turkish subpopulations by clearing or CBCT images. The prevalence of 2 or more root canals was found between 5.80% - 39.50% in mandibular first premolars and 1.1% -29% in mandibular second premolars in these studies. Conclusions: More attention should be paid to the detection of additional canals during root canal treatment of mandibular premolars, especially in male patients. The symmetrical morphology of the premolars may guide the practitioners during the root canal treatment. Evaluation methods could affect the results regarding root canal anatomy.
... The mandibular first premolar, which is often regarded as an enigma to endodontists, exhibits fascinating anatomic [20] 2 Not available Radiographic Not available Moayedi S et al. [21] 2 3 root canals Radiographic X Poorni S et al. [22] 2 3 root canals Radiographic X Kararia N et al. [23] 2 2 root canals Radiographic X Vaghela DJ et al. [24] 4 4 root canals Radiographic X Izaz S et al. [25] 2 4 root canals CBCT X Shen LC et al. [26] 1 4 root canals CBCT √ Zhang M et al. [27] 1 5 root canals CBCT X X: Taurodontism is not seen, √: Taurodontism seen ...
Successful root canal treatment requires a thorough understanding of the normal root canal anatomy and possible variations for each tooth. Variations in the root canal anatomy are frequently associated with complex orientations of pulp tissues and complicating mechanical and chemical debridement. Inability to manage such complications may result in endodontic failure. Mandibular first premolars often exhibit a wide range of anatomic variations, complicating clinicians' treatment. This clinical case report discusses the cone-beam computed tomography (CBCT) diagnosis and nonsurgical management of a taurodontic mandibular first premolar with two roots and four canals under a dental operating microscope (DOM). In endodontically challenging cases, using a DOM and CBCT imaging can help the clinician gain a better understanding of the complex root canal anatomy, allowing the clinician to more efficiently explore, clean, shape, and obturate the root canal system.
... The mandibular first premolar, which is often regarded as an enigma to endodontists, exhibits fascinating anatomic [20] 2 Not available Radiographic Not available Moayedi S et al. [21] 2 3 root canals Radiographic X Poorni S et al. [22] 2 3 root canals Radiographic X Kararia N et al. [23] 2 2 root canals Radiographic X Vaghela DJ et al. [24] 4 4 root canals Radiographic X Izaz S et al. [25] 2 4 root canals CBCT X Shen LC et al. [26] 1 4 root canals CBCT √ Zhang M et al. [27] 1 5 root canals CBCT X X: Taurodontism is not seen, √: Taurodontism seen ...
Successful root canal treatment requires a thorough understanding of the normal root canal anatomy and possible variations for each tooth. Variations in the root canal anatomy are frequently associated with complex orientations of pulp tissues and complicating mechanical and chemical debridement. Inability to manage such complications may result in endodontic failure. Mandibular first premolars often exhibit a wide range of anatomic variations, complicating clinicians' treatment. This clinical case report discusses the cone-beam computed tomography (CBCT) diagnosis and nonsurgical management of a taurodontic mandibular first premolar with two roots and four canals under a dental operating microscope (DOM). In endodontically challenging cases, using a DOM and CBCT imaging can help the clinician gain a better understanding of the complex root canal anatomy, allowing the clinician to more efficiently explore, clean, shape, and obturate the root canal system.
... 10-18%) of type C roots in the mandibular first premolar [21]. We have collated a number of case reports on the root canal morphology of the mandibular first premolar for nearly a decade, as detailed in Table 1 [19,[22][23][24][25]. According to the combination of many Fig. 3 3D reconstruction of the root canal of tooth #44 after filling. ...
Background:
Understanding the anatomical morphology of the root canal is key for successful root canal treatment. The aims of this case presentation are to report a unique case of root canal treatment involving five root canals in the mandibular first premolar and to highlight the importance of variation in root canals of mandibular first premolars in clinical practice.
Case presentation:
A 25-year-old male with intermittent pain in relation to the lower right posterior teeth over 3 weeks was diagnosed with symptomatic pulpitis in tooth #44. Four root canals were found, including mesiobuccal, distobuccal-1, distobuccal-2, and distolingual roots, and the Mtwo rotary system was used for root canal preparation. The four root canals were filled after 2 weeks, when a fifth canal was found, located in the buccal cavity. The fifth canal was confirmed to be the mesiolingual root canal by cone beam computed tomography (CBCT) and was found to be curved. After completion of the root canal filling, CBCT was performed, and a three-dimensional root canal image was reconstructed. After 1 week of observation, the tooth was repaired using composite resin filling.
Conclusions:
This is the first case presentation of a fifth canal of the mandibular first premolar and advances our understanding of variations in the anatomy of the mandibular first premolar. This case report provides a reference for the treatment of mandibular first premolars.
... For the mandibular premolars, PAN images could not detect teeth with more than two roots and two canals, though these are rarely reported and were here detected by CBCT. There are reports of first premolars from two to four roots, and up to four canals [19][20][21]. The same happens for the second premolar, for which there are reports from two to four roots, and up to five canals [22][23][24]. ...
... The endodontic literature so far revealed a high percent of cases with more than one canal in mandibular premolars [ Table 1]. [6,7,8,9] In a review of Blaine et al. (2013) which included eight studies found the majority of the mandibular first premolar had a single root in (97.9%). Two roots were found in 1.8% of the teeth studied. ...
Clinicians proceed the canal exploration according to the literature so far reported. At times, there are apparent variations in the teeth. These discrepancies should be thoroughly surveyed and piled up to date. One such rare complexity of canal morphology was discussed in the present case. A 48-year-old female patient referred to the endodontic clinic for full-mouth rehabilitation. On intraoral hard-tissue examination, decay was noted in multiple teeth which were confirmed by an orthopantomogram and endodontic treatment plan was suggested. The patient was prepared for the access opening of right mandibular first premolar (tooth #44) before which endodontic treatment of first and second quadrants was completed. The cone-beam computed tomography (CBCT) images revealed that tooth # 44 had two separate roots and four distinct root canals (mesiobuccal, mesiolingual, distobuccal, and distolingual). Root canal treatment was completed in two visits. Postoperative CBCT was advised to confirm the obturation of all the canals. © 2018 Journal of Conservative Dentistry | Published by Wolters Kluwer - Medknow.
... [2][3][4][5] Case reports in the recent endodontic literature based on ethnic background or geographical population analysis have concluded that this tooth can present itself with one root, two roots, and even three or more roots ("Ridiculous premolar.!!"). [6][7][8] Apart from having multiple roots and root canals, C-shaped canal configuration has also been documented in mandibular first premolars. [9,10] The significance of identifying a C-shaped canal lies in the fact that this complex canal configuration is difficult to clean, shape, and obturate. ...
... [14] The anatomic oddities encountered in mandibular first premolars as reported in the endodontic literature are as follows: two or three canals in one root or two roots; [15] three roots and three canals; [8] and four canals in four roots. [7] Lu et al. have coined the term "circumferential canals" for a distinctive canal configuration found in 6% of mandibular first premolars. [13] Failure to recognize the complex anatomy found in mandibular premolars could result in treatment failure, and hence, it is imperative for the clinician to have a comprehensive knowledge of the root canal anatomy. ...
Aim: The endodontic literature reports considerable variations in the root canal morphology of mandibular first premolars, including variations in number of roots and root canals. Additionally C-shaped canal configuration has also been documented in some case reports. Thus, the aim of this study was to determine the incidence of C-shaped canal morphology in mandibular first premolars in an Indian population.
Materials and Methodology: A total of 110 human mandibular left and right first premolars were collected. All teeth were subjected to CBCT exposures, made with the unit operating in continuous mode at 80 kV and 12 mA with an exposure time of 12s. CBCT images were analyzed using CS 3D Imaging Software 3.1 in the oblique cut.
Result: Out of 110 teeth, five teeth (4.54%) presented with the C-shaped canal configuration.
Conclusion: Limitations inherent in 2D imaging can be overcome by newer imaging techniques such as CBCT to better appreciate the variations in root canal anatomy.
... 2.7Morphology of the permanent mandibular posterior teeth. References: ( a )[ 171 ]; ( b )[ 144 ]; ( c )[ 217 ]; ( d ) ( u )[ 220 ]; ( v )[ 232 ]; ( w )[ 233 ]; ( x )[ 234 ]; ( y )[ 35 ]; ( z )[ 235 ]; ( aa )[ 147 ]; ( ab )[ 236 ]; ( ac )[ 237 ]; ( ad )[ 238 ]; ( ae )Fig. 2.8 ( a )Two-dimensional micro-CT cross section of the cervical third of a maxillary fi rst molar root showing the 2D parameter measurements of the four root canals. ...
The primary goals of endodontic treatment are to debride and disinfect the root canal space to the greatest possible extent and to seal the root canal system as effectively as possible, aiming to establish or maintain healthy periapical tissues. Treating complex and anomalous anatomy requires knowledge of the internal anatomy of all types of teeth before undertaking endodontic therapy. Recently, three-dimensional imaging of teeth using microcomputed tomography has been used to reveal the internal anatomy of the teeth to the clinician. This chapter is focused on the complexity of root canal anatomy and discusses its relationship on the understanding of the principles and problems of shaping and cleaning procedures.
... In addition to these numerous population studies, thirty-six case reports have also documented anatomic variations. The anatomic aberrations reported as endodontic case reports in the literature include mandibular first premolars with 2 or 3 canals in 1 root or 2 roots; 3 roots and 3 canals; and 4 canals in 4 roots (Table 4) [44][45][46][47][48][49][50][51][52][53][54][55][56][57][58][59]. Mandibular second premolars have shown variations that include 2, 3, 4, and 5 canals in 1 root; 2, 3, and 4 canals in 2 roots; 3 roots and 3 or 4 canals; (Table 5) [46,49,[53][54][55]. ...
Introduction. Mandibular premolars have been reported with complex anatomical aberrations, making them one of the most difficult teeth to manage endodontically. Methodology. An exhaustive search was undertaken to identify associated anatomic studies of mandibular premolars through MEDLINE/PubMed database using keywords, and a systematic review of the relevant articles was performed. Chi-square test with Yates correction was performed to assess the statistical significance of any anatomic variations between ethnicities and within populations of the same ethnicity. Documented case reports of variations in mandibular premolar anatomy were also identified and reviewed. Results. Thirty-six anatomic studies were analyzed which included 12,752 first premolars and nineteen studies assessing 6646 second premolars. A significant variation in the number of roots, root canals, and apical foramen was observed between Caucasian, Indian, Mongoloid, and Middle Eastern ethnicities.The most common anatomic variation was C-shaped canals in mandibular first premolars with highest incidence in Mongoloid populations (upto 24%) while dens invaginatus was the most common developmental anomaly. Conclusions. A systematic review of mandibular premolars based on ethnicity and geographic clusters offered enhanced analysis of the prevalence of number of roots and canals, their canal configuration, and other related anatomy.
