Methodological Approach to the Endodontic Treatment of First Premolars with Three Root Canals: Two Case Reports

Abstract

The aim of this article was to promote a methodology in the endodontic management of complex premolars with multiple root canals Background: The success of endodontic treatment depends on a meticulous clinical and radiographic analysis, the creation of a suitable access cavity and chemical and mechanical preparation, followed by three-dimensional filling of the entire root canal system. Consequently, it is essential to look for the presence of additional root canals to prevent endodontic treatment failure Case description: Two cases are presented. The first case concerned a 50-year-old male patient of North African origin who consulted in the context of a global prosthetic restoration including endodontic treatment of the maxillary left first premolar (tooth no. 24). The second case concerned a 29-year-old male patient of North African origin who was referred to us by his primary care practitioner in an urgent context of pain and infection present for two weeks (tooth no. 44). In both cases, it was the in-depth radiographic analysis, combined with manual exploration under the surgical micro- scope, that led to the relatively rare identification of a third root canal. Shaping, disinfection and three-dimensional filling of the entire root canal system were then performed in accordance with widely validated protocols. The maxillary and mandibular premolars, due to their highly variable root canal system configuration and a number of root canals and roots, appear to be teeth for which treatment is potentially complex. The acuteness of digital-tactile sense and the advent of 3D imaging and optical aids optimize the treatment of all the root canals of a tooth Clinical significance: These case reports demonstrate the importance of clinical and radiographic inspections to guide practitioners in the search for additional root canals in premolars and promote a methodological approach.