Abstract: Endodontic literature has described the standard anatomy of maxillary first premolar to have two roots and two canals. At the same time, there are many cases reports documenting numerous aberrations in its root canal morphology. This article showcases a documented case of an extracted three rooted premolar that was recovered during collections of samples for an in vitro study

Dr Ayush Goyal

Dr Karan Bansal

Dr Parul Bansal

Dr Pooja Arora

Dr Vipin Arora

CiteSeerX

 
 
 
DOI: 10.21276/sjds.2016.3.6.8                                 
    188 
 
 
Scholars Journal of Dental Sciences (SJDS)               ISSN 2394-496X (Online) 
Sch. J. Dent. Sci., 2016; 3(6):188-190                        ISSN 2394-4951 (Print) 
©Scholars Academic and Scientific Publisher       
(An International Publisher for Academic and Scientific Resources) 
www.saspublisher.com 
 
Case Report 
 
Three rooted maxillary first premolar- a case report 
Dr. Vipin Arora
1
, Dr. Parul Bansal
2
, Dr. Ayush Goyal
3
, Dr. Pooja Arora
4
, Dr. Karan Bansal
5
 
1
Professor and Course Director (Endodontics), Dept. of Restorative Dentistry, Faculty of Dentistry, Taif University, Taif, 
Kingdom of Saudi Arabia 
2
Reader, Dept. of Conservative Dentistry & Endodontics, Subharti Dental College, Meerut, Uttar Pradesh, India 
3
Lecturer, Dept. of Conservative Dentistry & Endodontics, Subharti Dental College, Meerut, Uttar Pradesh, India 
4
Professor (Prosthodontics), Dept. of Restorative Dentistry, Faculty of Dentistry, Taif University, Taif, Kingdom of 
Saudi Arabia 
5
Post-graduate student, Dept. of Conservative Dentistry and Endodontics, Subharti Dental College, Meerut, Uttar 
Pradesh, India 
 
*Corresponding author 
Dr. Vipin Arora  
Email: ayush2106_goyal@yahoo.in   
                   
Abstract: Endodontic literature has described the standard anatomy of maxillary first premolar to have two roots and 
two canals. At the same time, there are many cases reports documenting numerous aberrations in its root canal 
morphology. This article showcases a documented case of an extracted three rooted premolar that was recovered during 
collections of samples for an in vitro study. 
Keywords: premolar, root canal, endodontic treatment 
INTRODUCTION 
The visualization of the internal anatomy of 
teeth and a thorough knowledge of the root canal 
anatomy and its variations form the fundamental basis 
for a successful endodontic therapy [1]. In endodontic 
literature, the standard anatomy of maxillary first 
premolar has been described to have two roots (Buccal-
B and Palatal-P) and two canals (B and P) [2].
 
Three 
rooted maxillary premolars are uncommon (0.5-6%) [3-
6]. 
 
Three rooted maxillary first premolars have 
three anatomic variants; 1) three separate roots, 2) 
interfused buccal roots and 3) three interfused roots [7].
 
Maxillary first premolars with 3 separate roots 
frequently have one canal in each root. The anatomy of 
a maxillary premolar with three canals is similar to the 
adjacent maxillary molars and they are sometimes 
referred to as small molars or radiculous premolars [8].
 
 
Numerous factors influence the variations 
found in the root canal morphology including ethnic 
background, gender, method of data collection, sample 
size and the mode of studying the root canal space [9]. 
Three-rooted premolars are more frequent in Caucasian 
populations and practically non-existent in Asian 
populations [10]. 
 
This article aims to describe the root and canal 
morphology of a three rooted maxillary first premolar 
that was recovered during collections of samples for an 
in vitro study. 
 
TOOTH DESCRIPTION (Fig. 1) 
This right maxillary first premolar has three 
roots; two buccal and one palatal. The dimensions of 
the tooth are as follows: length- 21.08 mm; mesio-distal 
width- 8.14 mm; bucco-lingual width-10.16 mm. The 
bifurcation of the buccal roots and the trifurcation are at 
a distance of 7.5 mm and 6 mm from cement-enamel 
junction (CEJ) respectively. An Intraoral periapical 
radiograph (IOPAR) in relation to this tooth revealed 
the outlines of three roots and three distinct canals. 
 
Access cavity preparation (Fig. 2) was done to 
determine the number of root canals. The triangular 
access cavity of this premolar resembled that of a molar 
and three distinct orifices were located corresponding to 
three canals. Mesio-buccal (MB) and disto-buccal (DB) 
orifices were located in close proximity to each other 
and the palatal orifice was found to be located in line 
with the palatal cusp tip. 
 
 
Vipin Arora et al., Sch. J. Dent. Sci., Vol-3, Iss-6 (Jun, 2016), pp-188-190 
    189 
 
 
 
Fig.-1: a) to f): measuring the dimensions of the extracted three rooted maxillary first premolar 
 
 
Fig-2: Access cavity preparation of the tooth shows three distinct orifices 
 
DISCUSSION 
The process of identifying and determining the 
root canal morphology is particularly challenging in 
endodontic treatment of a tooth with atypical canal 
configuration. The maxillary first premolar has a highly 
variable canal and root morphology. Probably even 
today, many dentists treat maxillary premolars 
presuming them to have two canals. For a successful 
root canal treatment, it is essential to identify, clean and 
shape the root canal properly before placing a hermetic 
filling. The presence of an untreated canal; inadequate 
debridement and incomplete obturation of the root canal 
system are common reasons for failure of endodontic 
treatment [11].
 
A root canal may be left untreated 
because the dentist fails to recognize its presence. 
 
Visualization of three canals in a maxillary 
premolar on pre-operative radiographs can often be 
difficult. Although the pre-operative radiograph gives a 
two dimensional image of a three dimensional object, 
there are some guides that suggest the presence of a 
third canal/root. Whenever there is an abrupt 
straightening or loss of radiolucent canal in the pulp 
cavity, a third canal should be suspected, either in the 
same root or in the other independent root [12].
 
Also, 
whenever the mesio-distal width of the mid-root area is 
equal to or greater than the mesio-distal width of the 
crown, the tooth most likely has three roots and 
multiple canals are common when a radiograph shows 
an eccentrically placed instrument in roots [13]. 
 
Root canal orifices are the number one guide 
in determining the outline form of the access cavity. In 
the maxillary first premolar, an ovoid outline form is 
recommended. This figure of 8 shaped access restricts 
the expectation of the clinician to one or two root canal 
orifices [14]. A third canal should be suspected 
clinically when pulp chamber does not appear to be 
aligned in its expected bucco-palatal relationship.  
 
If the pulp chamber appears to deviate from 
normal configuration and seems to be either triangular 
 
Vipin Arora et al., Sch. J. Dent. Sci., Vol-3, Iss-6 (Jun, 2016), pp-188-190 
    190 
 
 
in shape or too large in a mesio-distal plane, more than 
one root canal should be suspected. In three rooted 
maxillary premolar, the buccal orifices are close to each 
other that are hard to locate. In treatment of three rooted 
maxillary first premolars, Balleri et al. suggested a T-
shaped access outline [14].
 
This modification allows 
good access to the two buccal canals. When confronted 
with unusual tooth anatomy as three rooted maxillary 
premolars, good illumination and magnification can 
make treatment easier. With the aid of an operating 
microscope or loupe, it is possible to locate all the root 
canal orifices. 
 
CONCLUSION 
Endodontic success in teeth with the number 
of canals more than that normally found requires a 
correct diagnosis and careful exploration. 
Morphological variations in root canal anatomy must 
always be considered before beginning the treatment. 
The case presented shows that an extra root canal and 
root may occur in maxillary premolars. Although the 
frequency is rare, each case should be evaluated 
carefully both clinically as well as radiographically. 
 
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permanent teeth. Oral Surg Oral Med Oral Pathol, 
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2. Gandhi B, Majety KK, Gowdra RH; Root canal 
treatment of bilateral three-rooted maxillary first 
premolars. J OrofacSci, 2012; 4:56-9. 
3. Hess W; Anatomy of the root canals of the teeth of 
the permanent dentition. Part 1. New York: 
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4. Pineda F, Kuttler Y; Mesiodistal and 
buccolingualroentgenographic investigation of 
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5. Carns EJ, Skidmore AE; Configurations and 
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7. Mohammadi Z, Shalavi S, Jafarzadeh H; Extra 
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9. Loh HS; Root morphology of the maxillary first 
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10. Walker RT; Root form and canal anatomy of 
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11. Sulaiman AO, Dosumu OO, Amedari Mc K; 
Maxillary first premolar with three root canals: a 
case report. Ann IbdPg Med, 2013; 11(2):105-8. 
12. Soares JA, Leonardo RT; Root canal treatment of 
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Case Report Three rooted maxillary first premolar-a case report

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Case Report Three rooted maxillary first premolar-a case report

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