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CASE REPORT Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 2  |  Page : 241-242
Three root canals in the maxillary second premolar

1 Department of Endodontics, University of Pernambuco, Brazil
2 Department of Endodontics, University of Fortaleza, Brazil

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Date of Submission06-Aug-2007
Date of Decision25-Oct-2007
Date of Acceptance04-Dec-2007
Date of Web Publication23-Jun-2009


In this study, we report an endodontic treatment of the maxillary second premolar with three root canals and distinct foramens. The possibility of three root canals in this tooth is quite small; however, it must be taken into account in clinical and radiographic evaluation during endodontic treatment. Many times, their presence is noticed only after canal treatment due to continuing post-operative discomfort.

Keywords: Dental anatomy, maxillary second premolar, root canal

How to cite this article:
de Almeida-Gomes F, de Sousa BC, de Souza FD, dos Santos RA, Maniglia-Ferreira C. Three root canals in the maxillary second premolar. Indian J Dent Res 2009;20:241-2

How to cite this URL:
de Almeida-Gomes F, de Sousa BC, de Souza FD, dos Santos RA, Maniglia-Ferreira C. Three root canals in the maxillary second premolar. Indian J Dent Res [serial online] 2009 [cited 2023 Mar 25];20:241-2. Available from:
A clear understanding of the root canal anatomy of the human dentition is a pre-requisite for conventional endodontic procedures. The anatomical complexities of root canal anatomy have been highlighted in the literature and the need for the clinician to understand probable aberrations was emphasized. [1]

Consistent, high levels of success in endodontic treatment require an understanding of root canal anatomy and morphology and that the entire root canal system must be debrided, disinfected and filled. Thus, it is necessary for the clinician to have knowledge of not only dental anatomy but also its variations. [2]

According to Ingle, [3] one of the most important causes of endodontic treatment failure is the incomplete obturation of the root canal system. Therefore, the correct location, clean, shape and obturation of all canals are indispensable procedures. Similarly, Vertuci [4] and De Grood and Cunninghan [5] reported that a considerable number of failures could be assigned to anatomical variations, such as the presence of canals not usually found.

Studies on maxillary premolars show a low incidence of three root canals. [6],[7],[8] Maxillary second premolars usually have one root with one or two root canals. Vertucci [4] reported the occurrence of one canal at the apex in them at 75% and two canals at the apex at 24%. In the same study, Vertucci [4] found maxillary second premolars with three canals at the apex to be only 1%.

This clinical case describes a maxillary second premolar with three root canals, two buccal and one palatal, with distinct foramens.

   Case Report Top

A 32-year-old male with non-contributory medical history was referred to our office complaining of discomfort associated with the left maxillary.

Clinical examination revealed a temporary restoration in the left maxillary second premolar. The tooth was very sensitive to percussion and was non-responsive to Endo Ice (Higenic Corp., Akron, OH, USA).

The tooth was isolated and the coronal access was prepared. Three root canals were found, two buccals and one palatal, which the initial radiographic exam did not suggest [Figure 1a]. The canals were cleansed and the length of each root canal was established using an electronic apex locator Root ZX (J. Morita, Kyoto, Japan). The root canals were prepared in a crown-down method. Sodium hypochlorite (2.5%) and ethylenediamminetetraacetic acid (17%) solutions were used as irrigants. The canals were filled by Tagger's Technique using gutta-percha points and a root canal sealer (Endofill; Denstply, Petropolis, Rio de Janeiro, Brazil). Treatment was executed in a single visit. After the filling, the final radiograph showed the three root canals with distinct foramens [Figure 1b].

   Discussion Top

According to Leonardo, [9] an inability to detect, locate, negotiate and instrument all root canals may lead to endodontic failure. The textbook describes in detail the "typical morphology" of any tooth, but one should always note published case reports presenting variations and/or irregularities of the pulp space.

Accurate pre-operative radiographs, straight and angled, using a parallel technique are essential in providing clues to the number of roots that exist. [10]

Endodontic success in teeth with the number of canals above that normally found requires a correct diagnosis and careful radiographic inspection. Morphological variations in pulpal anatomy must be always considered before beginning treatment. The case presented shows that an extra root canal may occur in the second maxillary premolar. Determining the developmental origin of this anatomical anomaly appeared to have clinical significance.

   Conclusion Top

Knowledge of dental anatomy is fundamental for good endodontic practice. Although the frequency of maxillary second premolars with three root canals with distinct foramens is rare, each case should be investigated carefully, clinically and radiographically, to detect the anatomical anomaly.

   References Top

1.De Deus QD. Frequency, location and direction of the lateral, secondary and accessory canals. J Endod 1975;1:361-6.  Back to cited text no. 1    
2.Baratto-Filho F, Fariniuk LF, Ferreira EL, Pecora JD, Cruz-Filho AM, Sousa-Neto MD. Clinical and macroscopic study of maxillary molars with two palatal roots. Int Endod J 2002;35:796-801.  Back to cited text no. 2    
3.Ingle JI. Endodonticas. 3 rd ed. Philadelphia, PA: Saunders; 1985.  Back to cited text no. 3    
4.Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol 1984;58:589-99.  Back to cited text no. 4    
5.De Grood ME, Cunningham CJ. Mandibular molar with five canals: Report of case. J Endod 1997;23:60-2.  Back to cited text no. 5    
6.Atieh MA. Root and canal morphology of maxillary first premolars in a Saudi population. J Contemp Dent Pract 2008;9:46-53.  Back to cited text no. 6    
7.Ferreira CM, de Moraes IG, Bernardineli N. Three-rooted maxillary second premolar. J Endod 2000;26:105-6.  Back to cited text no. 7    
8.Woodmansey KF. Endodontic treatment of a three-rooted maxillary first premolar: A case report. Gen Dent 2006;54:420-4.  Back to cited text no. 8    
9.Leonardo MR. Aspectos anatτmicos da cavidade pulpar: Relaηυes com o tratamento de canais radiculares. In: Leonardo MR, Leal JM, editors. Endodontia: Tratamento de canais radiculares. 3 rd ed. Sγo Paulo: Panamericana; 1998. p.191.  Back to cited text no. 9    
10.Silha RE. Paralleling long cone techic. Dent Radiogr Photogr 1968;41:3-19.  Back to cited text no. 10    

Correspondence Address:
Fabio de Almeida-Gomes
Department of Endodontics, University of Pernambuco
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0970-9290.52885

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  [Figure 1a], [Figure 1b]

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