Atypical anatomy of maxillary second premolar with three roots and four canals

Abstract

Knowledge and understanding the anatomical configuration of individual tooth play a significant role in success of endodontic treatment, in addition to through debridement and obturation of the canals. The canal anatomy of maxillary second premolar has been studied extensively, and the presence of a significant variety of multirooted canals is relatively rare in it. A 27-year-old female reported with a chief complaint of pain in her upper right posterior region for 10 days. On intraoral hard tissue examination, ill-defined access preparation was seen in maxillary right second premolar with exposed pulp. An intraoral periapical radiograph reveals radiolucency involving the pulp space and varied morphology in the same tooth. The occurrence of three roots with four canals in the maxillary second premolar is rare and not documented in the literature so far. This case report describes the nonsurgical endodontic management of such varied anatomical configuration using cone beam computed tomography as an evaluating diagnostic tool.

Keywords: Anatomical variations; cone beam computed tomography; four canals; maxillary second premolar.

Figure 1

(a and b) Angled preoperative radiographs, (c) working length radiograph

Figure 2

(a and b) Preoperative cone beam computed tomography axial view with four distinct root canals and sagittal view with three separate roots, (c) postoperative radiograph, (d) postoperative radiograph with crowns, (e) intraoral periapical radiograph with 1-year follow-up