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Case Reports
. 2022 Dec 2;9(12):757.
doi: 10.3390/bioengineering9120757.

Maxillary Premolars with Four Canals: Case Series

Calogero Bugea  1 , Denise Irene Karin Pontoriero  2   3 , Gaia Rosenberg  4 , Giacomo Mario Gerardo Suardi  5 , Gianmarco Calabria  6 , Eugenio Pedullà  7 , Giusy Rita Maria La Rosa  7 , Francesco Sforza  8 , Antonio Scarano  9 , Roberto Luongo  10 , Giovanni Messina  11
Affiliations
Case Reports

Maxillary Premolars with Four Canals: Case Series

Calogero Bugea et al. Bioengineering (Basel). .

Abstract

The aim of this case series is to contribute to the better knowledge and management of the complex anatomical configurations of maxillary premolars with four canals. The paper explains the endodontic treatment of five maxillary premolars with four canals, with three buccal and one palatal orifices, in different patients. The cases report several approaches in the treatment of four-canal maxillary premolars including a conservative canal preparation with a hybrid shaping technique, endodontic microsurgery and the application of biomaterials. The use of an operating dental microscope, different operating strategies and the critical evaluation of radiographs are all necessary steps for the correct and safe endodontic management of these teeth.

Keywords: MEA technique; anatomical variations; canal; coneless; maxillary premolars; root; root canal anomalies; root morphology; upper premolars.

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Conflict of interest statement

The authors deny any conflict of interest.

Figures

Figure 1
Figure 1
(a) Pre-operative X-ray showing the complex anatomy, (b) intra-operative X-ray after obturation of three canals, (c) intra-operative X-ray after obturation of the 4th canal, (d) intra-operative view of the three vestibular canals, (e) X-ray of 6-month follow-up.
Figure 2
Figure 2
(a) Pre-operative X-rays showing the complex anatomy, (b) intra-operative X-ray with endodontic instruments to better understand the anatomy, (c) post-operative view of the endodontic surgery, (d) orthograde filling with gutta-percha, (e) 1-year follow-up.
Figure 3
Figure 3
(a) Pre-operative view of the premolar, (b) flap design, (c) intra-operative view of the lesion, (d) ultrasonic tip in action, (e) intra-operative view of the retrograde obturation.
Figure 4
Figure 4
(a) Pre-operative view of the premolar, (b) post-operative X-ray of the four canals filled with gutta-percha (c) 1-year follow-up.
Figure 5
Figure 5
(a) Pre-operative view of the premolar, (b) post-operative X-ray of the four canals filled with gutta-percha, (c) 1-year follow-up.
Figure 6
Figure 6
(a) Pre-operative view of the premolar, (b) post-operative X-ray of the four canals filled with gutta-percha, (c) 1-year follow-up.
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