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Year : 2005  |  Volume : 8  |  Issue : 4  |  Page : 26-29
Endodontic treatment of a maxillary first premolar with three roots a case report

Deparment of Conservative Dentistry and Endodontics,The Oxford Dental College and Hospital, Bangalore., India

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The purpose of this paper was to report the possibility for successful endodontic treatment of a complex case of maxillary . first premolar with three roots and three canals. Radiographic interpretation and correct access cavity preparation were performed. Cleaning and shaping of the root canal followed by cold lateral gutta percha condensation was accomplished. The present report emphasizes the knowledge ofanatomical variations, clinical and radiographic interpretations in maxillary first premolar.

Keywords: Anatomical variations, First maxillary premolar; Root canal treatment.

How to cite this article:
Rekha SG, Nadig P, Nadig G. Endodontic treatment of a maxillary first premolar with three roots a case report. J Conserv Dent 2005;8:26-9

How to cite this URL:
Rekha SG, Nadig P, Nadig G. Endodontic treatment of a maxillary first premolar with three roots a case report. J Conserv Dent [serial online] 2005 [cited 2023 May 28];8:26-9. Available from:

   Introduction Top

According to endodontic literature, the possibility of morphological variations of root canal system is a known fact. For a successful root canal treatment, a detailed knowledge of the morphology of the root canal system, preoperative radiographs of good quality, tactile examination of both the pulpal floor and pulpal chamber and management of infection in the entire root canal system is required.

A slight deviation in root morphology is an additional challenge. The objectives of root canal treatment are mechanical cleaning, disinfection, and shaping of the entire root canal, complete obturation followed by its final coronal restoration.

The major causes of failures in endodontic treatment are untreated canals, incorrect canal instrumentation, and improper obturation. Kartal N et al examined 600 first and second maxillary first premolar, applying vertucci's classification only 1.66% of type VIl or type IX (three canals) was found. The frequency of three root canals found in maxillary first premolar is of 0.5-6%. [4],[5],[6] A study of 150 extracted maxillary first premolars from citizens of Seville, Spain was done by Chaparro AJ et al . he revealed that 5 teeth with 3 roots (3.3%).

   Case Report Top

A 21-year-old woman with a noncontributory medical history was referred to the department of conservative dentistry for the root canal treatment of her maxillary left first premolar.

The patient's chief complaint was pain in relation to her upper left back teeth region. Clinical examination showed a large coronal carious lesion with no evidence of swelling and sinus tract. Vitality test with heated gutta percha stick, and electric pulp tester revealed severe, rapid, lingering pain from the maxillary first premolar. Pre-operative periapical radiograph revealed deep occlusal caries involving the pulp and widening of periodontal ligament space in relation to 24, no evidence of periapical pathology was seen. Based on clinical and radiological evidence it was diagnosed as acute irreversible pulpitis.

The treatment was started with administration of local anesthesia using 2% lidocaine hydrochloride with 1:200,000 adrenaline. Tooth was isolated using rubber dam and caries removed prior to access opening. After access opening the three orifices were explored with endodontic probe which were in straight line bucco-palatally. The pulpal tissue was removed using barbed broach and coronal enlargement was made with Gates Glidden drill. A periapical radiograph was taken to confirm the presence of third root. working length was determined using Ingle's method. 10 size K file and 15 size K file in the buccal roots, 25 size K file in palatal root. The three canals were thoroughly instrumented using hybrid technique and apical preparation to a size of 30 in both buccal canals and to a size 40 in palatal canal was done. For irrigation of root canal 3% of hydrogen peroxide and 3% of sodium hypochloride were used. The tooth was dried with paper points and a cotton pellet was sealed into the pulp chamber with reinforced zinc oxide eugenol restorative material.

At the next appointment the root canals were obturated with ZOE sealer and using lateral compaction technique of gutta percha. A final radiograph was taken to confirm the quality of the obturation. Permanent restoration was done at the next appointment.

   Discussion Top

The variability of root morphology is a challenge to both endodontic diagnosis and treatment. The identification of the internal morphology as precisely as possible is the primary step in root canal treatment. According to Ouellet R studies, if the mesiodistal dimension at middle third or apical third is greater than at the cervix on radiograph, one can presume that maxillary first premolar has 3 roots. A through knowledge of root canal anatomy, multiple preoperative parallel radiographs as well as a mesial or distal shift radiographs and proper modification of the conventional access opening are essential for recognition and adequate treatment of teeth with different anatomical variations. [8] Martinez-lozano MA, concluded that varying the horizontal angle improved the visualization of additional (superimposed) canals in premolar, changing of the vertical angle had no statistically significant influence.

In this case, while determining working length there was sudden deviation of file in the pulp chamber towards buccal side, as to confirm the third canal a periapical radiograph was taken with the files in place. Determining correct working length of the root canals, proper cleaning and shaping followed by good obturation with impermeable apical seal are necessary for successful root canal treatment.

   Conclusion Top

An accurate knowledge of root canal morphology and with its anatomical variations is required for successful root canal treatment. A Complex root canal anatomy requires modifications in the access cavity. Turner CG suggested that multiple root number of maxillary first premolar can be defined on the basis of lingual and buccal-root bifurcation greater than one fourth to one third (25%-33%) the buccal-root. The frequency with which root canals unite or bifurcate should be considered during enlargement and filling procedures.[16],[Figure 1],[Figure 2],[Figure 3],[Figure 4].

   References Top

1.Aokik.: Morphological studies on the roots of maxillary premolars in Japanese. Shiktiva gakecho. 90, 181-189, 1990.  Back to cited text no. 1    
2.Bellizz R. and Hartwell G.: Radiographic evaluation of root canal anatomy of in- vivo endodontically treated maxillary premolars. J. of. Endod. 11, 37-41, 1985.  Back to cited text no. 2    
3.Cams E.J. and Skidmore A. E.: Configurations and deviations of root canals of maxillary first premolar. Oral Surg, Oral Med & Oral Path. 36, 880-886, 1973.  Back to cited text no. 3    
4.Chaparro A.J., Segura J.J., Guerrero E., Jimenez-Rubio A., Murillo C. and Feito J.J.: Number of roots and canals in maxillary first premolars. Endod. Dent. Traumotol. 15, 6567, 1999.  Back to cited text no. 4    
5.Hess W.: Anatomy of the root canals of the teeth of the permanent dentition part I. New York. Wiliam Wood. 3-49, 1925.  Back to cited text no. 5    
6.John 1. Ingle and Leif K. Bakland.: Endodontics. Fifth edition, 416-417, B.C. Decker pub. 2002  Back to cited text no. 6    
7.Kartal N., Ozcelik B. and Cimilli H.: Root canal morphology of Maxillary premolars. J. Endod. 24, 84-94, 1992.  Back to cited text no. 7    
8.Maibaum W.W.: Endodontic treatment of a ridiculous maxillary premolar: a case report. General. Den. 37. 340-01, 1989.  Back to cited text no. 8    
9.Martinez-Lazano M.A., Forner-Navarrol and Sanchez-Corter J.1.: Analysis of radiologic factors in determining premolar root canal system. Oral surg, Oral Med, Oral path, Oral radiol Endod. 88, 719-722, 1999.  Back to cited text no. 9    
10.10.Ouellet R.: How to predict the presence of three rooted maxillary premolars. J. Can. Dent. Assoc. 60, 912-914, 1994.  Back to cited text no. 10    
11.11.Pecora J.D., Saquv P.C., Sousa Neto M.D. and Woelfel J.B.: Root form and canal anatomy of maxillary first premolars. Braz. Dent. J. 2, 87 94, 1992.  Back to cited text no. 11    
12.12.Pineda F. and Kuttler Y.: Mesiodistal and buccolingual roentgenographic investigation of 7275 root canals. Oral Surg. Oral Med. & Oral Path. 33, 101-10, 1972.  Back to cited text no. 12    
13.13.Soares J.A and Leonardo R.T.: Root canal treatment or three rooted maxillary first and second premolars-A case report. I. Endod. J. 36, 705-710, 2003.  Back to cited text no. 13    
14.14.Tunner C.G. 2 nd.:Root number determination in maxillary first premolar for modem human polpulations. Ain. J. Phvs. Anthropol. 54, 5962, 1981.  Back to cited text no. 14    
15.15.Vertucci F.J. and Gegauff A.: Root canal morphology of the maxillary first premolar. J. Ain. Dent. Assoc., 99, 194-198, 1979.  Back to cited text no. 15    
16.16.Zaatar ET, Al- Busairi M.A. and Behbahani M.J.: Maxillary first premolar with three root canals- Case report. Quintess. Int. 21, 100711, 1990.  Back to cited text no. 16    

Correspondence Address:
Shashi G Rekha
Deparment of Conservative Dentistry and Endodontics,The Oxford Dental College and Hospital, Bangalore.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-0707.42594

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

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