The tricky lower first premolar with 4 canals
30/10/2023
Abdulwahab Al-Qaraghuli
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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.
Fig. 1
Initial situation of referred lower first premolar with temporary filling
Fig. 2
Pre-op xray showing the abnormal anatomy
Fig. 3
After temporary filling removal and rubber dam isolation
Fig. 4
gates glidden was used to enlarge the coronal third of the canal
Fig. 5
Files in the canals
Fig. 6
Working length determination to the four canals
( distal , mesial , buccal , lingual )
Fig. 7
Rotary file was separated during the instrumentation of distal canal
Separated instrument removal by loop technique
Fig. 8
Separated file was successfully retrieved by BTR pen
Fig. 9
Files reached the full working length in all canals
Fig. 10
Sodium hypochlorite in action
Fig. 11
The stars refer to the canals orifices (Distal , Mesial , Buccal , Lingual)
Fig. 12
Cone fit X-rays
Obturation
Fig. 13
Obturation in process
Fig. 14
Clean chamber
Fig. 15
Final restoration
Fig. 16
Post-op X-ray
Fig. 17
2 years follow up
Conclusions
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
Bibliography
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