I/
On access, one buccal and one palatal canal were located. The
canals were debrided and a working length radiograph was taken
The working length radiograph revealed the presence of an extra
root, which was not apparent in the initial radiograph
The access opening was widened mesio-distally and exploration
with an endodontic explorer revealed a second buccal canal, which
was mesially placed The mesio-buccalcanal was significantly smaller
than disto-buccalcanal The canals were enlarged up to I S 0 size 35
(K-file) using sodium hypochloriteand normal Saline as irrigants. The
canals were then obturated with gutta-percha and zinc oxide
eugenol-based sealer, using a cold lateral compaction technique
(Fig I , I-iii)
A male patient aged 27 years came with a complaint of severe
pain in left maxillary second premolar tooth. The tooth required
endodontic treatment and its radiograph revealed three roots and
hence the possibility of three canals.
A regular access opening was carried out One buccal and one
palatal canal were located The buccal canal that had been located
Figure 2 (iv top. v /eft. vi below):
Case 2 - access photograph and
workrng length and obturotion
radiographs.
was distally placed. which prompted a search for a second buccal
canal in the mesial direction. The access opening was modified. the
buccal half of the access opening was slightly enlarged in a mesio-
distal direction and this uncovered a second mesio-buccal canal.
The mesio-buccal and disto-buccalcanals were enlarged up to size
30 and the palatal canals up to I S 0 size 40 using a step-back
preparation. Sodium hypochlorite and normal saline were used as
irrigants. Obturation was completed with gutta-percha and zinc
oxide eugenol-based sealer, using a cold lateral compaction
technique (Fig 2. iv-vi)
Case 3
A female patient aged 20 years came with a complaint of pain
in the right maxillary second premolar tooth. The tooth was
diagnosed as having an irreversible pulpitis and an intraoral
radiograph revealed three roots and three canals
Figure 3 (vii top. viii middle. ix above) Caw 3 pre-oprotive. master
point and obturotion rodiqraphs
AUSTULIAN ENDODONTIC IOURNAL VOLUMt 3 I No. 2 AUGUST 2005
 A routine access opening with slight widening in the mesio-distal
direction was carried out Two buccal canals (one mesial and one
distal) and one palatal canal were located Both the buccal canals
were of the same size These canals were enlarged up to I S 0 size
30 (K-file) using a step-back preparation. The palatal canal was
enlarged up to I S 0 size 40. Sodium hypochlorite and normal saline
were used as irrigants The canals were obturated with gutta-
percha zinc oxide eugenol-based sealer. using a cold lateral com-
paction technique (Fig. 3. vii-ix)
Discussion
Previous studies done on extracted teeth have reported that the
chances of maxillary second premolars having three roots and three
canals are less than I% (3) The percentage of occurrence in our
department was I 36%
Missed canals could be one of the reasons for failure of root
canal treatment If it is possible to detect the extra canal during the
diagnosis stage. it helps the dentist plan the treatment beforehand
However. overlapping of the canals in a radiograph could give an
erroneous picture Taking pre-operative radiographs from two
different horizontal angles. but the same vertical angle (tube-shift
technique). can help in identifyingextra canals (6)
In case the canals are missed while studying the radiograph. the
location of the orifice of the root canal can arouse suspicion about
the possibility of an extra canal For example, after removing the
pulp chamber roof. the orifices of buccal and palatal canals are
expected to be centrally-placedin a maxillary first premolar If one
of the canals is eccentrically located. it should immediately raise the
suspicion about an extra canal
The access opening for maxillary second premolars is usually oval
in the bucco-palatal direction In all the above reported cases, the
access opening was modified The crowns of all these teeth were
broader mesio-distally The access cavities were slightly widened
in the mesio-distal direction to uncover the second buccal canal
(7. 8. 9) The completed access cavity preparationwas triangular in
outline resembling the access opening for a maxillary first molar, but
smaller in size (Fig 4)
F i q m 4 Recommended occes
cnvlry form to explore for
wspcred rhird cords rri moxillory
\ecorid prernolor teeth
AUS r PALIAN LNOOOONTIC IOUR’JAL VOLUML.: i NO L AUGUST ims
Conclusion
The cases in this repott were presented for their rarity. Know-
ledge about the basic root canal anatomy and its variations IS
essential in achieving a higher percentage of success in endodontics
( 10). Multiple-angledradiographs of the tooth to undergo root canal
treatment will often reveal the presence of extra or aberrant canals.
Careful examination of the floor of the pulp chamber reveals clues
for locating any extra canals Access cavity preparation needs to be
modified to uncover these extra canals.
References
I . Stewart GG. Evaluation of endodontic results. Dent Clin
NorthAm 1967; I1:71 1-22.
2. Vertucci FJ. Root canal anatomy of the human permanent
teeth. Oral Surg 1984; 58589-99.
3. Vertucci F. Seelig A. Gillis R. Root canal morphology of the
human maxillary second premolar. Oral Surg 1974;
38:456-64.
4. Pecora JD. Sousa Neto MD. Saquy PC. Woelfel JB. In vitro
study of root canal anatomy of maxillary second premolars.
Braz Dent J 1993; 3:8 1-5.
5. Kartal N, Ozcelik B. Cimilli H. Root canal morphology of the
human maxillary premolar.J Endod 1998; 24:4 I7 19.
6. Bellizzi R, Hartwell G. Radiographic evaluation of root canal
anatomy of m vivo endodontically treated maxillary premolars.
J Endod 1985: I I :37-9.
7. Weir C. Clinical example of locating the mesio-lingual canal of
a maxillary first molar. Aust Endod Newsletter 1997; 23:34--5.
8. Gentner M. The treatment of a mandibular second pre-
molar with three root canals. Aust Endod Newsletter 1995;
2 I :24-6.
9. Krasner !? Rankow HJ.Anatomy of the pulp chamber floor.
J Endod 2004; 305- 16.
10. Slowey RR. Root canal anatomy. Road map to successful
endodontics. Dent Clin Noith Am 1979; 2 3 5 5 5 73.
Int ernati onal ‘I’ooth
Avulsion Rescarch
Projecto
Temple University School of Dentistry
and Lorna Linda School of Denlistry
This research project is concerned with the factors that
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