Endodontic Treatment of Bilateral Maxillary First Premolars with Three Roots Using CBCT: A Case Report

One of the determining factors for the success of endodontic therapy is understanding the morphological anatomy of the tooth structure and its variants in relation to its template anatomy. The internal anatomy of maxillary first premolars is particularly complex due to their variation in number of roots and canal configuration. However, the bilateral presence of three roots in a maxillary first premolar is of rare occurrence. This case report describes the unusual anatomy bilaterally detected in maxillary first premolars using Cone-Beam Computed Tomography. 1. Introduction Thorough knowledge of the internal anatomy of teeth is essential before an operator can rationally approach any endodontic procedure. The anatomical and structural complexities of the root canal should be effectively assessed and efficiently approached for successful endodontic therapy. An extra root is an additional challenge which begins at case assessment and involves all operative stages, including cavity design, canal access, localization, cleaning and shaping of the root canal system, and proper obturation [1]. The internal anatomy of the maxillary first premolar is particularly complex due to its variation in number of roots and canal configuration [2]. In the case of maxillary first premolar, three root canals are found at a frequency of 0.5–6% [3, 4]. 2. Case Report A 34-year-old female patient has reported to the Department of Conservative Dentistry and Endodontics, MNR Dental College and Hospital, Sangareddy, with a chief complaint of pain in the upper right and left back tooth region for a week. Her medical history was noncontributory. Clinical examination of the area of chief complaint revealed dental caries with tenderness on percussion. Based on clinical findings, radiographic interpretation, and vitality tests, a diagnosis of acute apical periodontitis in relation to right and left maxillary first premolar was made and endodontic therapy was planned. On further examination of the radiographs, an abrupt loss of radiolucency in the pulp canal was noticed in relation to right and left first premolar region. The mesiodistal root diameter was greater than the mesiodistal width of the crown (Figure 1). With these findings, a possible anatomical tooth variation was suspected in relation to right and left first premolar region and reconfirmed using Cone-Beam Computed Tomography (Gentex), Figure 2. Figure 1: OPG showing three rooted bilateral first premolar; mesiodistal root diameter was greater than the mesiodistal width of the crown. Figure 2: CBCT images of 14 and 24. The