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CASE REPORT

Endodontic Treatment of a Maxillary First


Premolar with Type IV Buccal Root Canal: A Case
Report
1*

Bahareh Dadresanfar , Zohreh Khalilak , Solaleh Shahmirzadi

Department of Endodontics, Dental School, Islamic Azad University/Member of Iranian Center for Endodontic
Research, Tehran, Iran

Dental Student, Tehran, Iran

ABSTRACT

The maxillary first premolar may present large number of anatomic variations. The clinician should be aware
of the configuration of the pulp system. Maxillary first premolars usually have two canals. The incidence of
three canals in these teeth is quite rare. This case report presents the diagnosis and clinical management of a
maxillary first premolar with two distinct canals in the apical third of buccal root (type IV), drawing
particular attention to tactile examination of all the canal walls.

KEYWORDS: Bicuspid; Maxilla; Root Anatomy; Type IV Canals

Received: 26 May 2008; Revised: 19 Oct 2008; Accepted: 07 Dec 2008

*Corresponding author at: Bahareh Dadresanfar, Department of Endodontics, Dental School, Islamic
Azad University, No 4, Pasdaran Ave., 10th Niestan St., Tehran, 19468, Iran. Tel: +98-2122236384, Fax: +982166726808 E-mail: bahareh_torabi@yahoo.com

INTRODUCTION

CASE REPORT

Inadequate instrumentation will often lead to


endodontic failure; additional root canals may
be missed in cases with anatomic variations (1).
The maxillary first premolar may present with a
large number of anatomic variations; one
possible variation is the presence of an extra

canal. This is an additional challenge that should


be addressed initially during case assessment as
well as all the operative stages, from the access
cavity design to the obturation of the root canal
system (2). The reported frequency of three root
canals in maxillary premolars varies from 0.56% (3-6), generally with one canal in each of

three roots (7). According to Weine's


classification a canal that leaves the pulp
chamber and divides short of the apex into two
separate apical foramina, is called type IV canal

(8). In Vertucci's classification of root canal


configurations this is called type V (9).
Thorough literature search only found one study
discussing type IV Weine's configuration in the
buccal root of maxillary first premolar (10).
Matuella et al. examined 39 buccal roots of
maxillary first premolar with longitudinal
sulcus. A staggering 34.3% of cases had type IV
canal configuration in their buccal root (10).
This case report describes the successful
diagnosis and treatment of maxillary first
premolar with a type IV Weine's canal
configuration in buccal root.

A 24-year-old male with a non-contributory


medical history sought treatment at the Dental
School of Islamic Azad University. The chief
complaint was "pain on chewing". Clinical
examination showed a large carious lesion
with pulp exposure. The tooth was not
sensitive to cold testing with Endo frost
(Roeko, Langenau, Germany) or electronic

IEJ

-Volume 4, Number 1, Winter 2009

35

pulp testing (Vitality Scanner, Analytic


technology, Glendora, CA, USA).
Investigations for swelling, sinus tract and
periodontal involvement were negative; the
pulp was diagnosed as necrotic. Preoperative
radiographs revealed no periapical
involvement of the periodontal ligament space
and very vague outline of two separate roots
(Figure 1).

To ease rubber dam placement, anesthesia was


obtained using Persocaine-E (DarouPakhsh
Co, Tehran, Iran). A rubber dam was placed
and an access cavity was prepared. In the floor
of pulp chamber only two orifices were
detected. Even with the exploration of the
access cavity, no other orifices were found.
Using two K-file size #15 (Dentsply,
Maillefer, Switzerland) the working length
was determined radiographic-ally. This
radiograph revealed two canals with a vague
outline for the buccal root.

A #15 file with severe precurve in the apical


third was placed alongside to the file in the
buccal canal and a radiograph was taken. This

Dadresanfar et al.

al
root
,
thre
e
can
als
wer
e
neg
otia
ted

Fig
ure
1.
Pre
ope
rati
ve
radi
ogra
ph,
sho
win
g
cari
es
and
ver
y
vag
ue
two
sep
arat
e
root
s in
first
pre
mol
ar
toot
h

F
ig
u
re
2.
In
iti
al
ra
di
og
ra
ph
,
re
ve
ali
ng
tw
o
ca
na
ls
wi
th
a
va
gu
e
ou
tli
ne
fo
r
th
e
bu
cc

Fig
ure
3.
Post
ope
rati
ve
radi
ogra
ph
foll
owi
ng
the
obt
urat
ion
of
the
one
pala
tal
and

two
buc

radi
ogra
ph
conf
irm
ed
the
divi
sion
of
buc
cal
can
als
into
two
sepa
rate
root
s in
the
apic
al
thir
d
(Fig
ure
2).
The
n
bio
mec
hani
cal
prep
arati
on
was
carr
ied
out
with
5.25
%
Na
OCl
as

ca
l

can
als

the
irrig
ant.
Mas
ter
apic
al
files
#25
in
the
buc
cal
can
als
and
#30
in
the
pala
tal
can
al
wer
e
sele
cted
,
subs
equ
entl
y,
obtu
rati
on
was
carr
ied
out
with
gutt
aperc
ha
and
AH
26
seal
er

(De
ntsp
ly,
DeT
rey,
Kon
stan
z,
Ger
man
y)
usin
g
later
al
con
den
sati
on
tech
niqu
e
(Fig
ure
3).

DI
SC
US
SI
ON

Iden
tifyi
ng
and
acce
ssin
g all
root
cana
ls is
parti
cula
rly
chal
leng
ing
in

the
end
odo
ntic
treat
men
t of
teet
h
with
atyp
ical
cana
l
conf
igur
atio
n.
The
max
illar
y
first
pre
mol
ar
has
a
high
ly
vari
able
cana
l
and
root
mor
phol
ogy,
freq
uent
ly
with
two
sepa
rate
cana
ls
and
two
fora
min
a
(72

%)
(4).
In
treat
men
t of
thre
eroot
ed
max
illar
y
first
pre
mol
ars,
Ball
eri
et
al.
(11)
sug
gest
ed a
Tshap
ed
acce
ss
outli
ne.
Afte
r
thor
oug
h
expl
orati
on
no
othe
r
orifi
ces
wer
e
foun
d
with
in
the
pulp
cha

mbe
r
floo
r
save
the
one
buc
cal
and
one
pala
tal
cana
l.
The
cruc
ial
step
in
find
ing
the
addi
tion
al
buc
cal
cana
l
was
tacti
le
exa
min
atio
n of
all
maj
or
buc
cal
wall
s
with
a
sma
ll,
prec
urve
d Kfile
tip.
Afte

r
loca
ting
the
cana
ls,
spec
ial
atte
ntio
n
sho
uld
be
paid
to
root
cana
l
prep
arati
on,
so
the
obtu
ratio
n
and
her
meti
c
seal
of
the
cana
ls
wou
ld
be
poss
ible.
It is
prob
able
that
if
this
cana
l
had
not
bee
n
instr

ume
nted
and
obtu
rate
d, a
succ
essf
ul
resu
lt
may
not
hav
e
bee
n
achi
eve
d.
This
case
remi
nds
us
to
be
vigil
ant
whe
n
treat
ing
max
illar
y
first
pre
mol
ars.

CO
NC
LU
SI
ON

Clin
icia
n

sho
uld
be
awa
re of
vari
atio
ns
relat
ed
to
cana
l
conf
igur
atio
n
and
type
in
max
illar
y
first
pre
mol
ars.
Tact
ile
sens
atio
n
and
insp
ecti
on
of

can
al
wall
s
with
sma
ll
prec
urve
d
files
to
reco

gniz
e
and
loca
te
uns
usp
ecte
d
can
als
is
extr
eme
ly
imp
orta
nt.

Con
flict
of
inte
rest
:
non
e
decl
are
d.

RE
FE
RE
NC
ES

Slo
wey
RR.
Root
cana
l
anat
omy
.
Roa
d

map
to
succ
essf
ul
endo
dont
ics.
Dent
Clin
Nort
h
Am.
197
9;23
:555
-73.

Javi
di
M,
Zare
i M,
Vata
npo
ur
M.
End
odo
ntic
treat
men
t of
a
radi
culo
us
max
illar
y
pre
mol
ar: a
case
repo
rt. J
Oral
Sci.
200
8;50
:99102.

Belli
zzi
R,
Hart
well
G.
Radi
ogra
phic
eval
uati
on
of
root
cana
l
anat
omy
of in
vivo
endo
dont
icall
y
treat
ed
max
illar
y
pre
mol
ars.
J
End
od.
198
5;11
:37-

Carn
s EJ,
Skid
mor
e
AE.
Con
figur
atio
ns
and
devi
atio
ns

of
root
cana
ls of
max
illar
y
first
pre
mol
ars.
Oral
Surg
Oral
Med
Oral
Path
ol.
197
3;36
:880
-6.

Hess
W.
Anat
omy
of
the
root
cana
ls of
the
teeth
of
the
per
man
ent
dent
ition
.
Part
I.
New
York
:
Will
iam
Woo
d
and
Co.,
192

5:349.

Pine
da F,
Kutt
ler
Y.
Mes
iodis
tal
and
bucc
olin
gual
roen
tgen
ogra
phic
inve
stiga
tion
of
7,27
5
root
cana
ls.
Oral
Surg
Oral
Med
Oral
Path
ol.
197
2;33
:101
-10.

Vert
ucci
FJ,
Geg
auff
A.
Root
cana
l
mor
phol
ogy
of

the
max
illar
y
first
pre
mol
ar. J
Am
Dent
Ass
oc.
197
9;99
:194
-8.

Wei
ne
FS.
End
odo
ntic
Ther
apy.
5th
Editi
on.
St
Loui
s:
Mos
byYear
boo
k;19
96.
Vert
ucci
FJ.
Root
cana
l
anat
omy
of
the
hum
an
per
man
ent
teeth
.

Oral
Surg
Oral
Med
Oral
Path
ol.
198
4;58
:589
-99.

Matt
uella
LG,
Maz
zocc
ato
G,
Vier
FV,
S
MV.
Root
cana
ls
and
apic
al
fora
min
a of
the
bucc
al
root
of
max
illar
y
first
pre
mol
ars
with
long
itudi
nal
sulc
us.
Braz
Dent
.J
200
5;16

:239.

Ball
eri P,
Gesi
A,
Ferr
ari
M.
Prim
er
prem

olar
supe
rior
con
tres
race
s. J
End
od
Pract
.
1997
;3:13
-5.

36

IEJ

-Volume 4, Number 1, Winter 2009

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