Non-surgical endodontic treatment of premolars with three root canals: a case reports

To perform successful endodontic therapy, it is important to know the anatomy and morphology of the root canal system. Peculiarities with possible anatomic variations may lead to failure due to insufficient instrumentation and inadequate three-dimensional obturation of the root canal system.[1,2] Accurate radiographic examination using different horizontal angles is crucial for the endodontist to recognize the roots and root canals. Additionally, the observation of the pulp chamber anatomy during coronal access is an essential procedure for the correct clinical location of root canal orifices.[3] The high frequency of endodontic flare-ups and failures is associated with variation in root canal morphology. The factors that can contribute to observed differences in the anatomic study include ethnicity, age, gender and study design (in vitro versus in vivo).[4] The presence of three root canals in maxillary premolars of the Turkish population is a very rare occurrence as reported by several studies.[5–7] The presence of three root canals in mandibular premolars of the Turkish population is also a very rare occurrence as reported by Sert et al. and Ok et al. studies.[7,8] The use of magnification and fiber optic illumination, offers a tremendous advantage in locating and treating “extra” canals. Also the dental operating microscope (DOM), has been found to be particularly helpful. The efficient use of the DOM requires advanced training. Many endodontic procedures are performed at 10× to 15× magnification, and some require a magnification as high as 30×. The skillful use of a DOM entails its use for the entire procedure from start to finish. Working in such a way requires the endodontist to possess a high level of ergonomic and visual skills.[9] This paper reports the endodontic treatment of three cases of three-canalled maxillary premolars in different patients and the endodontic treatment of one case of threecanalled mandibular premolars in a different patient. An accurate diagnosis of the morphology of the root canal system is a prerequisite for successful root canal treatment. Some reports reveal a very rare occurrence of all types of premolar teeth in the Turkish population. Diagnostic tools such as preoperative radiography and examination of the pulp chamber floor facilitate the location of root canal orifices. The use of magnification tools, radiography exposed at two different horizontal angles, and their careful explication are important for successful endodontic therapy. This case report presents the successful endodontic treatment of three maxillary premolar teeth with three root canals and one mandibular premolar tooth with three root canals.