JOURNAL OFENDODONTICS Printed m U.S.A.

Copyright 0 2000 by The American Association of Endodontists VOL. 26, No 5, MAY2000

Five Canals in a Mandibular Second Premolar

Elsa Macri, DDS, and Osvaldo Zmener, DDS, DrOdont

A case of conservative endodontic therapy for a

mandibular second premolar with five root canals
is described. A thorough knowledge of the root
canal anatomy, careful interpretation of the radio-
graphs, and access cavity modifications are es-
sentials for enhancing intracanal procedures.

Numerous studies have investigated the root canal configuration of

mandibular second premolars (1-4). In most instances they had
one canal (1, 3) but teeth with two or more canals were also
reported (1, 4-11). The presence of extra root canals may be
occasionally detected in the preoperative radiograph, but-in gen-
eral-they are more often not seen in the original film. Failure to FIG 1. Preoperative radiographof right mandibular second premolar.
recognize and treat any additional canal may prevent successful
root canal therapy. Consequently, awareness of the possible exis-
tence of these anatomical variations would be important during the mesiolingual aspect of the tooth. Surprisingly, an unexpected
endodontic treatment of mandibular second premolars. This report fifth canal orifice located toward the distobuccal aspect of the
discusses the endodontic therapy of a mandibular second premolar cavity floor was also detected. Files were inserted into the canals
with five root canals. and a length-measuring radiograph was taken. The file placed in
the newly detected fifth canal merged with the distobuccal canal at
the apex of a suspected third root, which seemed to be very short
CASE REPORT (Fig. 2). The canals were then biomechanically prepared and
finally, they were filled by lateral condensation of gutta-percha
A 58-yr-old female with a noncontributory medical history was cones and Grossman’s sealer (Fig. 3). The occlusal access opening
referred to our office for endodontic treatment of the mandibular was sealed with a temporary filling and a final radiograph was
right second premolar. The patient said that she had received
emergency treatment 3 wk previously, but the tooth was still
symptomatic and hyperreactive to percussion. Clinical examina-
tion revealed that the crown structure of the premolar was partially
lost. In the preoperative radiograph, the outline of the periodontal
ligament contour suggested the presence of two roots. In addition,
a broad root canal has split into more than two distinct canals at the
coronal-root level, with the central branch being wider (Fig. 1).
From the combined patient history and clinical examination, a
diagnosis of acute apical periodontitis was established. To facili-
tate rubber dam isolation, an interim buildup (12) consisting of a
bonded composite was made on the remaining coronal surfaces.
After administering local anesthesia, the tooth was isolated and all
remaining decay was removed. To gain sufficient access to the
canals, the conventional access opening was modified into one that
was wider buccolingually and slightly extended mesiodistally on
the buccal aspect. After careful inspection, four canal orifices were
located: one mesiobuccal, one distobuccal, one lingual (recognized FIG2. Length-measuringradiographshowing instrumentsin five root
as the wider canal), and another situated somewhat more toward canals.

304
Vol. 26, No. 5, May 2OOO
FIG4. Postoperative radiograph with all canals filled. Superimposi-
tion with the distobuccal root canal makes difficult a view of the
obturated fifth canal.
taken (Fig. 4). A second radiograph was taken from a distal angle
to obtain a better view of the obturated canals (Fig. 5). Two weeks
later, the tooth was free of symptoms.
DISCUSSION
Mandibular second premolars are undoubtedly an endodontic
challenge, especially because the presence of extra roots or root
canals may occur far more often than one can expect (1,s-11). A
thorough knowledge of root canal anatomy, careful interpretation
Mandibular Premolar with Five Canals 305
of the radiographs, and proper modification of the conventional
access opening seem to be essentials for recognition and adequate
treatment of these anatomical variations.
Dr. Macri and Dr. Zmener are affiliated with the Department of Adult Dental
Care, Section Endodontics, Faculty of Odontology, University of Euenos
Aires, Buenos Aires, Argentina. Address requests for reprints to Dr. Elsa
Macri, Department of Adult Dental Care, Section Endodontics, Faculty of
Odontology, University of Euenos Aires. Marcelo T. De Alvear 2142 (1122),
Buenos Airas, Argentina.
REFERENCES
1. Zillich R, Dowson J. Root canal morphology of mandibular first and
second premolars. Oral Surg 1973;36:738-44.
2. Kerekes K, Tronstad L. Morphometric observations on root canals of
human premolars. J Endodon 1977;3:74-9.
3. Vertucci FJ. Root canal morphology of mandibular premolars. J Am
Dent Assoc 197897:47-50.
4. ElDeeb ME. Three root canals in mandibular second premolars: litera-
ture review and a case report. J Endodon 1982;8:376-7.
5. Trope M, Elfenbein L, Tronstad L. Mandibular premolars with more than
one root canal in different race groups. J Endodon 1986;12:343-5.
6. England MC, Hartwell GR,Lance JR. Detection and treatment of mul-
tiple canals in mandibular premolars. J Endodon 1991;17:174-8.
7. Fisher GM, Evans CE. A three-rooted mandibular second premolar. Gen
Dent 1992;40139-40.
8. Shapira Y, Delivanis P. Multiple-rooted mandibular second premolars. J
Endodon 1982;8:231-2.
9. Glassman G. Flare-up with associated paresthesia of a mandibular
second premolar with three root canals. Oral Surg 1987;64:110-3.
10. Wong M. Four root canals in a mandibular second premolar. J End-
odon 1991;17:1256.
11. Holtzman L. Root canal treatment of mandibular second premolar with
four root canals: a case report. Int Endod J 1998;31:364-6.
12. Greene RR, Sikora FA, House JE. Rubber-dam application to crown-
less and cone-shaped teeth. J Endodon 1984;10:82-4.