The tricky lower first premolar with 4 canals
The mandibular first premolar can be considered one of the most challenging teeth for the endodontist during endodontic procedures; because of the complexity of its root canal morphology and increased incidence of multiple canals. The knowledge of internal anatomy of root canals and their possible variations as well as use of magnification, operating microscope, radiographic examination and illumination, can increase the chances of finding additional canals and contribute to the success of endodontic treatment.
Initial situation of referred lower first premolar with temporary filling
Pre-op xray showing the abnormal anatomy
After temporary filling removal and rubber dam isolation
gates glidden was used to enlarge the coronal third of the canal
Files in the canals
Working length determination to the four canals
( distal , mesial , buccal , lingual )
Rotary file was separated during the instrumentation of distal canal
Separated instrument removal by loop technique
Separated file was successfully retrieved by BTR pen
Files reached the full working length in all canals
Sodium hypochlorite in action
The stars refer to the canals orifices (Distal , Mesial , Buccal , Lingual)
Cone fit X-rays
Obturation in process
2 years follow up
This case report presents the successful endodontic treatment of a mandibular first premolar with Four Canals. It is essential to always consider variations in pulp anatomy and morphology before the beginning of root canal treatment. Utilizing magnification tools, e.g. a microscope, to magnify the internal anatomy of a root canal increases the probability of finding additional canals. Furthermore, radiographic examination is imperative when endodontic treatment is to be successful. If canals are identified and negotiated correctly, complex premolars’ anatomy can be treated predictably
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