IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-ISSN: 2279-0853, p-ISSN: 2279-0861.Volume 20, Issue 5 Ser.3 (May. 2021), PP 14-16 www.iosrjournals.org DOI: 10.9790/0853-2005031416 www.iosrjournal.org 14 | Page Endodontic Treatment of Mandibular Second Premolar with Three Root Canals Dr.Greeshma S 1 , Dr. B.S Keshava Prasad 2 1 (Post graduate student, Department of Conservative Dentistry and Endodontics, D.A.P.M R.V Dental College, Bangalore) 2 (Professor and Head of the Department, Department of Conservative Dentistry and Endodontics, D.A.P.M R.V Dental College, Bangalore). Abstract: Apart from the usual single root and single canal, mandibular premolars can present a complex pulp anatomy. Hence a thorough knowledge of root canal anatomy and along with anatomical variation that may be present is essential for the success of any endodontic treatment. Good magnification and CBCT scan will definitely be beneficial for successful endodontic treatment. This case report details the treatment of mandibular second premolar with three canals and three orifices. Key Word: Mandibular second premolar, aberrant canal anatomy --------------------------------------------------------------------------------------------------------------------------------------- Date of Submission: 29-04-2021 Date of Acceptance: 13-05-2021 --------------------------------------------------------------------------------------------------------------------------------------- I. Introduction Success of endodontic treatment requires understanding of root canal anatomy and morphology. Unusual presentations in the number of the canals or the roots should be anticipated in every tooth. Out of all the teeth, Mandibular premolars are one of the most difficult teeth to treat endodontically because of the variations in their root canal anatomy This is mainly due to the variations in internal morphology of the pulp cavity considering the number of root canals, apical deltas, and lateral canals. In addition, the access cavities are relatively small, which reduces the visibility. The prevalence of 3 root canals with 3 orifices was reported to be 0.4% by El Deeb in 1982. The occurrence of 3 canals in mandibular second premolars has been reported as 0-0.4%. [4] The occurrence of 3 canals with 3 separate roots with 3 separate foramina (type V, Vertucci) is very rare. Dentists have been treating the mandibular second premolar under the assumption that they have only one canal and one root. However, all studies have pointed out that a root with a tapering canal and a single foramen is an exception rather than the rule. [6] hoen and Pink found a 42% incidence of missed roots/canals in the teeth that needed re treatment. [7] The use of magnification and fibre optic illumination offers a tremendous advantage in locating and treating extra canals. This case report details an endodontic management of mandibular second premolar where 3 canals with 3 different roots II. Case Report A 26-year-old female with a non-contributory medical history reported to our hospital with a chief complaint of “pain in right lower posterior region”, Clinical examination revealed caries in relation to 45. The tooth was tender on percussion. Radiograph examination revealed a complex root canal system, evidenced by sudden change in the radiographic density of the root canal space at the middle of the root. More than two root canals were suspected. A diagnosis of chronic irreversible pulpitis with apical periodontitis was made. Non-surgical endodontic treatment was planned for tooth 45 with calcium hydroxide as interappointment, intracanal medicament The patient was anesthetized with 2% lidocaine and 1:100,000 epinephrine. After rubber dam isolation, access to the pulp chamber was made. Two orifices were immediately found on a line connecting buccal cusp and lingual groove. Gates Glidden drills were used in a crown down method to enlarge the main orifice to the level of trifurcation for a straight-line access to all the three canals. Irrigation was done using 5.25% sodium hypochlorite. Working length was estimated using an apex locator. Working length confirmed using periapical radiograph. All the canals were cleaned and shaped using K files and rotary protaper files (Dentsply). Calcium hydroxide was used as intracanal medicament for 2 weeks and the access cavity was sealed with IRM.