Fig. 1

A young female patient came to my clinic complaining from a severe pain related to lower right area , she had pain for about 1 month , the previous dentist suggested that there was a calcification, and he was facing a blockage , then she was addressed to my clinic The Pre-Operative Xray Shows an enlargement of the periodontal ligament Space and disappearing of the main canal in the mid root that confirming a Split related to tooth No. 44

Fig. 2

Access Cavity after Pre-Endo buildup & Refinement  

Fig. 3

Scouting of the main canal " Lingual " was easy but the difficulty was in how to catch and scout the buccal canal so I made some refinement of the access cavity in Bucco-lingual direction then i pre-curved the smallest St. St. manual file " 8k " and made the file sliding up & down alongside the lingual wall without rotation to avoid any changes in the tip direction and made its pre-curved tip toward the buccal wall until I could get a catch 

Fig. 4

 This Pic shows the effervescence action of irrigation while heating 

Irrigation Protocol was 5.25 % Naocl , 17 % EDTA Solution and Alcohol heated by FastPack & Activated by Ultrasonic " Ultra X device "  

Fig. 5

-I shaped the root canals up to 30.04 with Controlled memory files 

Fig. 6

I cut the gutta-percha 4-5 mm apical from the apex by down packing technique using FastPack device 

Fig. 7

Obturation of the buccal & Lingual canal at the Split level 

Fig. 8

Back-filing of the whole canal Space by thermoplastisized GP Using Fastfill Device 

Then the case was refereed back to the previous dentist for completion of the final restoration

Fig. 9

Tooth No. 35 with Coronal Split into 2 canals 

Fig. 10

A- Trials to Catch the buccal canal

B- Catching & Scouting the Canal 

C- Check Master cone Fitting

D&E - obturation by WVC Tech.

This video shows us how to obturate the canals at the split level in tooth No. 35

Fig. 11

Other Scenario of Diagnosis & Management of Mandibular 1st Premolar with three canals 

During taking a working length Xray , I revealed that we hade a fast break phenomenon apically that suggests a Split in tooth No. 34

Then I tried to scout in more than one direction in order to catch other canals 

Fig. 12

Clinical Pic Shows 3 Canals Apically " L , MB & DB "

Fig. 13

All canals were prepared up to  25.04 using CM Files                   

Fig. 14

I put each Master cone Separately and cut it at the split level using fastback device 

Fig. 15

Obturation by WVC Technique Using Fast-fill device , then restored the tooth with resin composite 

Fig. 16

1st premolar “ tooth no. 34 “  also has a division in the coronal 1/3 into three canals and managed by the same protocol that we discussed before


The Outcome of endodontic treatment can be jeopardized by a lack of anatomical knowledge and a poor attention to the Preoperative Xray Never underestimate the case you deal with especially the mandibular premolars  A careful examination of the pre-operative x-ray can help the clinician in identifying such anatomic peculiarities in order to select the strategy and the correct instruments before starting the root canal therapy.


1- Albuquerque D, Kottoor J, Hammo M. Endodontic and clinical considerations in the management of variable anatomy in mandibular premolars: a literature review. Biomed Res Int. 2014;2014:512574. doi: 10.1155/2014/512574. Epub 2014 May 8. PMID: 24895584; PMCID: PMC4034431.

2- Kararia N, Chaudhary A, Kararia V. Mandibular left first premolar with two roots: A morphological oddity. Contemp Clin Dent. 2012 Apr;3(2):234-6. doi: 10.4103/0976-237X.96840. PMID: 22919233; PMCID: PMC3425116.

3- Arnaldo Castellucci, Endodontics text book, Access Cavity and Endodontic Anatomy P.244.

4- Vertucci FJ. Root canal morphology of mandibular premolars. J Am Dent Assoc


5- England MC Jr, Hartwell GR, Lance JR. Detection and treatment of multiple canals in mandibular premolars. J Endod 1991;17:174 – 8.