Endodontic Treatment of a Mandibular Second Premolar with Type IV Wiene’s Root Canal: A Case Report

This case report describes an endodontic treatment of a mandibular second premolar with type IV root canal. A 26-year-old male patient reported pain in right mandibular second premolar. Clinical examination showed a large carious lesion with pulp exposure. Radiographs showed minimal periapical changes and slight widening of periodontal ligament space. Mandibular second premolars usually have one canal. The mandibular second premolar may present large number of anatomic variations. The clinician should be aware of the configuration of the pulp system. This case presents the diagnosis and clinical management of a mandibular second premolar with two distinct canals in the apical third of root (Type IV Wiene’s canal configuration), drawing particular attention to tactile examination of all the canal walls and obturating it with calamus 3D obturation system. 1. Introduction Knowledge of basic root and root canal morphology as well as possible variation in anatomy of the root canal system is important in achieving successful nonsurgical root canal treatment (NSRCT). This is followed by negotiation, cleaning and shaping, and obturation of the entire canal system in 3 dimensions [1]. According to Weine a root canal can be present in four types: Type I—single canal from pulp chamber to apex; Type II—two canals leaving the chamber and merging to form a single canal short of the apex; Type III—two separate and distinct canals from chamber to apex; Type IV—one canal leaving the chamber and dividing into two separate apical foramina [2]. The mandibular premolars are difficult to treat as they have a high flare-up and failure rate. It may be due to the extreme variations in root canal morphology. Normally the root canal system of the mandibular second premolar is wider buccolingually than mesiodistally with two pulp horns. At the cervical line the root and canal are oval; this shape tends to become round as the canal approaches the middle of the root. If two canals are present, they tend to be round from the pulp chamber to their foramen. Another anatomic variation is that a single, broad root canal may bifurcate into two separate root canals. Direct access to the buccal canal is usually possible, whereas the lingual canal may be very difficult to find. The lingual canal tends to diverge from the main canal at a sharp angle. In addition, the lingual inclination of the crown tends to direct files buccally, making location of a lingual canal orifice more difficult [3]. This case report describes the successful diagnosis and treatment of mandibular second premolar with