Endodontic treatment of mandibular premolars with root canal variations: a case series

Year 2025, Volume: 26 Issue: 1, 24 - 30, 28.03.2025

Elife Ülkü Tatar , Esra Balkanlıoğlu , Aliye Kamalak

Abstract

Mandibular premolar teeth predominantly have a single root and canal. However, they may sometimes present with additional roots and canals. The objective of this study is to provide a comprehensive literature review on mandibular premolar teeth with extra roots and canals, as well as to retrospectively evaluate four cases from shaping to obturation. A literature review was conducted on cases involving the number of roots and canals in mandibular premolar teeth with additional roots and canals between 2021 and 2024. The diversity of root canal configurations in mandibular premolars was assessed using PubMed and Google Scholar databases. Patients presenting with endodontic treatment needs were evaluated at the Endodontics Clinic of Kahramanmaraş Sütçü İmam University Faculty of Dentistry Hospital. Patients with mandibular premolar teeth exhibiting additional root and canal variations were selected, and endodontic treatment of these teeth was performed using personalized treatment methods tailored to each case. A review of the literature revealed that while mandibular premolar teeth predominantly have a single root, variations in root morphology, including two roots, three roots, taurodontism, and C-shaped configurations can occur. These variations may be accompanied by diverse canal structures ranging from one to five canals with various configurations. It was found that 78.3% of mandibular first premolars and 90.3% of mandibular second premolars had single canals. The frequency of double-rooted premolars was found to be higher in males compared to females. During the examination of our cases, difficulties in accessing the root canal system were frequently encountered when additional root canals were present, requiring the adaptation of standard root canal treatment techniques to meet individual patient needs. Consequently, extended treatment durations were needed, often requiring multiple treatment sessions compared to standard root canal therapy. A literature review revealed that mandibular premolar teeth with extra roots and canals exhibit highly diverse canal configurations. However, such cases require extended treatment durations with multiple sessions and personalized treatment techniques tailored to each case due to the difficulty in accessing the root canal system.

Keywords

Additional root, additional canal, accessory canal, mandibular premolar teeth

Ethical Statement

Hastalardan onam alındı

Supporting Institution

yok

Project Number

yok

Thanks

yok

References

• Cleghorn BM, Christie WH, Dong CC. The root and root canal morphology of the human mandibular first premolar: a literature review. J Endod. 2007;33(5):509-516. doi:10.1016/j.joen.2006.12.004
• Induja M, Chokkattu JJ. Root canal morphology of mandibular premolars: CBCT analysis. Int J Health Sci. 2022(II):11936-11943. doi:10. 53730/ijhs.v6nS2.8222
• Karobari MI, Batul R, Khan M, et al. Micro computed tomography (micro-CT) characterization of root and root canal morphology of mandibular first premolars: a systematic review and meta-analysis. BMC Oral Health. 2024;24(1):1. doi:10.1186/s12903-023-03624-5
• Arévalo L, Oporto GH, Chuhuaicura P, et al. Root canal treatment of mandibular first premolar with 3 canals: a case report. Int J Morphol. 2024;1(2):2.
• Balkanlıoğlu E, Şimşekyılmaz Z. Evaluation of root canal morphology molar teeth and distance between additional canals using CBCT. HRU Int J Dent Oral Res. 2024;4(2):30-37. doi:10.61139/ijdor.1517056
• Aras SD, Borkar AC, Mujumdar SV, Maral SA, Barbhai SS, Gambhir AS. Endodontic management of an aberrant root canal anatomy: a case report and literature review. Front Oral Maxillofac Med. 2024;6. doi:10. 21037/fomm-22-68
• Xu M, Ren H, Liu C, Zhao X, Li X. Systematic review and meta-analysis of root morphology and canal configuration of permanent premolars using cone-beam computed tomography. BMC Oral Health. 2024;24(1): 656. doi:10.1186/s12903-024-04419-y
• Rae O, Parashos P. Prevalence and morphology of different root canal systems in mandibular premolars: a cross-sectional observational study. Aust Dent J. 2024;69(2):112-123. doi:10.1111/adj.12994
• Gurav T, Sormare Y, Thakare A, Jadhav V. Solving the mystery: a case study on treating a mandibular first premolar with multiple canals. Cureus. 2024;16(7):e63734. doi:10.7759/cureus.63734
• Wolf TG, Anderegg AL, Wierichs RJ, Campus G. Root canal morphology of the mandibular second premolar: a systematic review and meta-analysis. BMC Oral Health. 2021;21(1):309. doi:10.1186/s12903-021-01668-z
• Rödig T, Hülsmann M. Diagnosis and root canal treatment of a mandibular second premolar with three root canals. Int Endod J. 2003; 36(12):912-919. doi:10.1111/j.1365-2591.2003.00750.x
• Shimada Y, Kojima I, Nishioka T, Sakamoto M, Iikubo M. Root canal narrowing patterns of mandibular first premolars on panoramic radiographs according to the number of root canals diagnosed on cone beam computed tomographic images. Odontology. 2023;111(1):172-177. doi:10.1007/s10266-022-00713-9
• Liang CY, Chen WX. Diversity of root canal morphology in mandibular first premolars and its clinical strategies. Chinese J Stomatol. 2023;58(1): 92-97. doi:10.3760/cma.j.cn112144-20221017-00534
• Sibal A, Patel A, Singi SR, Bagde A. Two rooted mandibular second premolar: an unusual finding. Cureus. 2022;14(5):e25550. doi:10.7759/cureus. 25550
• Mohammadi M, Zarei M. Endodontic management of a mandibular second premolar with three root canals and taurodontism: a case report. Iran Endod J. 2024;19(3):228-231. doi:10.22037/iej.v19i3.45174
• Solete P, Priscilla Antony SD, Teja KV, Chandragupta MS, Sanju D, Suresh Babu NM. Endodontic management of aberrant canal morphology in mandibular premolar: a case series. J Conserv Dent. 2023;26(2):236-240. doi:10.4103/jcd.jcd_548_22
• Brar PK, Brar R, Vashisht R, Gambhir RS. Root canal treatment of a mandibular second premolar with unusual anatomy: a rare case report. J Datta Meghe Institute Med Sci Univ. 2023;18(3):500-502. doi:10.4103/jdmimsu.jdmimsu_307_23
• Davaji M, Valizadeh M, Karimpour S. Detection and endodontic treatment of unusual anatomic variations in second premolars: a case report. Iran Endod J. 2023;18(4):254-258. doi:10.22037/iej.v18i4.41716
• Mahdavisefat E, Kazemi A, Moghtaderi Esfahani E. Endodontic management of three-rooted mandibular first premolar using cone-beam computed tomography: a case report. Iran Endod J. 2023;18(2):122-125. doi:10.22037/iej.v18i2.41169
• Awooda EM, Elyas EEM, Al-Nazhan SA. Conventional root canal treatment of a mandibular second premolar with three roots and three canals performed by an undergraduate student: a case report with 8-year follow-up. Saudi J Oral Sci. 2023;10(3):201-206. doi:10.4103/sjoralsci. sjoralsci_57_23
• Jain R, Mala K, Shetty N, Bhimani N, Kamath PM. Endodontic management of mandibular anterior teeth and premolars with Vertucci’s type VIII canal morphology: a rare case. J Conserv Dent. 2022;25(2):197-201. doi:10.4103/jcd.jcd_518_21
• Niavarzi S, Ghabraei S, Malekpour F. Mandibular second premolar with four canals: a case report. Iran Endod J. 2022;17(4):209-211. doi:10.22037/iej.v17i4.38604
• Arroyo-Bote S. Use of cbct in the endodontic management of a second mandibular premolar with three roots: clinical case. J Clin Exp Dent. 2022;14(1):e107-e113. doi:10.4317/jced.58612
• Shah SA. Endodontic management of mandibular second premolar with Vertucci root canal configuration type V. Case Rep Dent. 2022;2022: 3197393. doi:10.1155/2022/3197393
• Penukonda R, Pattar H, Siang Lin GS, Kacharaju KR. Cone-beam computed tomography diagnosis and nonsurgical endodontic management of a taurodontic mandibular first premolar with two roots and four canals: a rare case report. J Conserv Dent. 2021;24(6):634-639. doi:10.4103/jcd.jcd_580_21
• Nouroloyouni A, Lotfi M, Milani AS, Nouroloyouni S. Endodontic management of a two-rooted mandibular first premolar with five root canals with cone-beam computed tomography: a case report. J Dent (Shiraz). 2021;22(3):225-228. doi:10.30476/DENTJODS.2020.83376.1049
• Dalaei Moghadam M, Farahi F. Endodontic treatment of bilateral mandibular first premolars with three root canals: a report of two cases. Iran Endod J. 2021;16(4):261-264. doi:10.22037/iej.v16i4.34781