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Review Article
Private Practice, 1Department of Endodontics, School of Dentistry, University of Athens, Athens, Greece
Key words:
Endodontic treatment, mandibular
premolars, multiple root canals, pulp
space anatomy
ABSTRACT
Objectives: This article investigates the internal and external morphological
variability of mandibular premolars along with clinical and radiographical signs
that leads to early identification of these cases. Materials andMethods: The
authors identified articles by searching the PubMed, Medline and Scopus
databases. Inclusion criteria were case reports of mandibular premolars
with aberrant internal and external anatomy, articles that describe the origin
of anatomy of mandibular premolars, the traits that may influence their
external and internal variability through species revolution and articles of new
technologies like cone beam computed tomography that help the diagnosis
of difficult cases. Results: In the majority of the cases, mandibular premolars
are reported to have one root canal running a single root. On the other hand,
anatomic irregularities in this group of teeth, such as the existence of more
than one root or more than one root canals or even a more complicated
root canal system cannot be considered infrequent as it appears in 1025%
of the cases. Conclusion:Successful endodontic treatment of mandibular
premolars is a challenge for the clinician as they often present morphological
and anatomical abnormalities.
INTRODUCTION
10
Table1: The cases reported for both first and second mandibular premolars, along with the anatomical
root configurations and root canal locations
Reference
Cleghorn etal., 2008[17]
Tooth
number
#44
Root
number
3
Root
canalnumber
3
#34
#34
#34
1
1
3
3
2
3
Nallapati, 2005[3]
Nallapati, 2005[3]
Rodig and Hulsmann,
2003[21]
Shokouhinejad, 2009[22]
#44
#45
#35
1
1
3
3
3
3
#35
AlFouazan, 2001[24]
#35
Rhodes, 2001[25]
Tzanetakis etal., 2007[26]
Holtzman, 1998[27]
Farmakis, 2008[28]
Sachdeva etal., 2007[11]
#35
#35
#45
#35
#35
2
1
1
4
4
4
4
4
4
4
#45
De Moor and
Calberson, 2005[23]
#45
12
Root configuration
Mesiobuccal,
distobuccal, lingual
One mesial
2 Two distal
Mesial, distal
Distal
Mesial
Mesiobuccal
DISCUSSION
A complicated root canal system poses a challenge
in every phase of endodontic therapy; thus, if not
accomplished correctly, the success rate is expected to
be lower a tenet that applies to premolars.[33]
The complex internal anatomy of first premolars and
the high rate of congenital absence and variations in
the external anatomy of second premolars[34] can be
attributed in part to genetic traits and evolutionary
patterns.
Modern people belong to the developed species
Homo sapiens. Early humans, such as early Homo,
were dentally similar to African apes. [35] Specifically,
mandibular premolars had crown outlines that
approximated molars, with more cusps, wider
mesialdistal and buccallingual dimensions and multiple
roots that were wider. [36] Further, these teeth had a
broad occlusal polygon surface and an asymmetrical
outline.[37,38]
According to the tritubercular theory of dental
evolution, proposed by Cope and then Osborn in the
late 19thcentury, multicusped teeth, such as molars
and premolars in mammals, developed through cusp
budding of simple conical teeth.[39,40]
As humans evolved, the dimensions of mandibular
premolars decreased due to selective pressures.[36] It is
unclear when the unique, prolonged human pattern of
growth and development originated.[35]
Saudi Endodontic Journal Jan-Apr 2013 Vol 3 Issue 1
CONCLUSION
Endodontic therapy of mandibular premolars, because
of their frequent morphological and anatomical
abnormalities, is a challenge for the clinician. On each
given case, robust knowledge of the literature(both
statistical data and case reports equally), a thorough
study and analysis of the external and internal
morphology and careful interpretation of the
radiographic imaging, is needed, in order to achieve a
high degree of success in their treatment.
Figure5: Cone beam computed tomography imaging revealing both
right mandibular premolars with three root canals
ACKNOWLEDGMENT
14
REFERENCES
1. IngleJI. Astandardized endodontic technique utilizing newly
designed instruments and filling materials. Oral Surg Oral Med
Oral Pathol 1961;14:8391.
2. WaltonRE, VertucciFJ. Internal anatomy. In: WaltonRE,
TorabinejadM, editors. Principles and Practice of Endodontics. 2nd
ed. Philadelphia, PA, USA: W.B. Saunders Co.; 1996. p. 16679.
3. NallapatiS. Three canal mandibular first and second premolars:
Atreatment approach. JEndod 2005;31:4746.
4. CleghornBM, ChristieWH, DongCC. The root and root
canal morphology of the human mandibular first premolar:
Aliterature review. JEndod 2007;33:50916.
5. CleghornBM, ChristieWH, DongCC. The root and root
canal morphology of the human mandibular second premolar:
Aliterature review. JEndod 2007;33:10317.
6. VertucciFJ. Root canal morphology of mandibular premolars.
JAm Dent Assoc 1978;97:4750.
7. BarretMT. The internal anatomy of teeth with special reference
to the pulp and its branches. Dent Cosm 1925;67:58192.
8. AmosER. Incidence of bifurcated root canals in mandibular
bicuspids. JAm Dent Assoc 1955;50:701.
9. GreenD. Double canals in single roots. Oral Surg Oral Med
Oral Pathol 1973;35:68996.
10. MiyoshiS, FujiwaraJ, Tsuji YNakataT, YamamotoK. Bifurcated
root canals and crown diameter. JDent Res 1977;56:1425.
11. SachdevaGS, BallalS, GopikrishnaV, KandaswamyD.
Endodontic management of a mandibular second premolar with
four roots and four root canals with the aid of spiral computed
tomography: Acase report. JEndod 2008;34:1047.
12. GaribDG, PeckS. Extreme variations in the shape of mandibular
premolars. Am J Orthod Dentofacial Orthop 2006;130:31723.
13. AshM. Development and eruption of the teeth. In: Wheelers
Dental Anatomy, Physiology and Occlusion. 7thed. Philadelphia:
W.B. Saunders; 1992. p.2438.
14. GrossmanLI. Endodontic Practice. Philadelphia: Lea and
Febiger; 1970. p.18190.
15. ZillichR, DowsonJ. Root canal morphology of mandibular
first and second premolars. Oral Surg Oral Med Oral Pathol
1973;36:73844.
16. VertucciFJ. Root canal anatomy of the human permanent teeth.
Oral Surg Oral Med Oral Pathol 1984;58:58999.
17. CleghornBM, ChristieWH, DongCC. Anomalous mandibular
premolars: Amandibular first premolar with three roots and a
mandibular second premolar with a Cshaped canal system. Int
Endod J 2008;41:100514.
18. England MC Jr, HartwellGR, LanceJR. Detection and
treatment of multiple canals in mandibular premolars. JEndod
1991;17:1748.
19. PoorniS, KarumaranCS, IndiraR. Mandibular first premolar
with two roots and three canals. Aust Endod J 2010;36:324.
20. JafarzadehH, WuYN. The Cshaped root canal configuration:
Areview. JEndod 2007;33:51723.
21. Rdig T, Hlsmann M. Diagnosis and root canal treatment of a
mandibular second premolar with three root canals. Int Endod
J 2003;36:9129.
22. ShokouhinejadN. Root canal retreatment of a mandibular
second premolar with three root canals: Acase report. Aust
Endod J 2009;35:1802.
23. De MoorRJ, CalbersonFL. Root canal treatment in a
mandibular second premolar with three root canals. JEndod
2005;31:3103.
24. AlFouzanKS. The microscopic diagnosis and treatment of a
mandibular second premolar with four canals. Int Endod J
2001;34:40610.
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