Management of a mandibular first premolar with two roots and three canals: a case report
https://doi.org/10.36377/ET-0190
Abstract
INTRODUCTION. The mandibular first premolar presents a diagnostic challenge in endodontics, often referred to as the “endodontist’s enigma”, due to its unpredictable and complex internal morphology. While the typical configuration involves a single root and one canal, significant anatomical aberrations can lead to treatment failure if missed. This report details the non-surgical management of a rare anatomical variant: a mandibular first premolar with two distinct roots and three separate canals.
CASE PRESENTATION. A 25-year-old female patient presented with symptomatic irreversible pulpitis associated with tooth #44. Preoperative radiography indicated an unusual two-rooted anatomy with a low bifurcation. Using a dental operating microscope for access refinement, a careful clinical inspection confirmed the presence of three canals: one lingual and two buccal. Biomechanical preparation was achieved using heat-treated rotary files. The three canals were disinfected using 5.25% sodium hypochlorite and 17% EDTA with ultrasonic activation. Obturation was performed using the single-cone technique combined with a bioceramic sealer for a complete and hermetic seal.
CONCLUSIONS. This successful case underscores that treating extreme anatomical complexity, such as a two-rooted mandibular first premolar with three canals, relies heavily on heigh clinical suspicion and advanced endodontic technology. The meticulous use of the operating microscope, ultrasonic tips, and flexible NiTi files is essential to locate, prepare, and seal all parts of the root canal system, thereby ensuring a predictable clinical outcome.
About the Authors
R. Habbachi
University of Sousse; University of Monastir
Tunisia
Competing Interests:
Tunisia
Roua Habbachi – Department of Restorative Dentistry and Endodontics, Faculty of Dental Medicine; Research Laboratory LR12SP10, University Hospital of Farhat Hached
Monastir, Tunisia; Sousse, Tunisia
Competing Interests:
The authors declare no conflict of interests.
S. Bagga
University of Monastir
Tunisia
Competing Interests:
Tunisia
Sana Bagga – Department of Conservative Dentistry and Endodontics, Laboratory of Dento-Facial Clinical and Biological Approach (ABCDF) LR12ES10, Faculty of Dental Medicine
Monastir, Tunisia
Competing Interests:
The authors declare no conflict of interests.
W. Elleuch
University of Monastir
Tunisia
Competing Interests:
Tunisia
Wassim Elleuch – Department of Conservative Dentistry and Endodontics, Laboratory of Dento-Facial Clinical and Biological Approach (ABCDF) LR12ES10, Faculty of Dental Medicine
Monastir, Tunisia
Competing Interests:
The authors declare no conflict of interests.
S. Sahtout
University of Monastir
Tunisia
Competing Interests:
Tunisia
Saida Sahtout – Department of Conservative Dentistry and Endodontics, Laboratory of Dento-Facial Clinical and Biological Approach (ABCDF) LR12ES10, Faculty of Dental Medicine
Monastir, Tunisia
Competing Interests:
The authors declare no conflict of interests.
References
1. Slowey R.R. Root canal anatomy. Road map to successful endodontics. Dent Clin North Am. 1979;23(4):555–573.
2. Hargreaves K.M., Cohen S., Berman L.H. Cohen’s Pathways of the Pulp Expert Consult. 10 th ed. Mosby, Elsevier; 2010. 1008 p.
3. Vertucci F.J. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol. 1984;58(5):589–599. https://doi.org/10.1016/0030-4220(84)90085-9
4. Vertucci F.J. Root canal morphology of mandibular premolars. J Am Dent Assoc. 1978;97(1):47–50. https://doi.org/10.14219/jada.archive.1978.0443
5. Sundesha M., Choudhary A. A morphological oddity in man dibular left second premolar with two roots: a case report. Int J Adv Res. 2023;11(2):922–925. Available at: https://www.journalijar.com/uploads/2023/02/640edbf31defd_IJAR-42378.pdf (accessed: 03.03.2026).
6. Ahmed H.M.A., Versiani M.A., De-Deus G., Dummer P.M.H. A new system for classifying root and root canal morphology. Int Endod J. 2017;50(8):761–770. https://doi.org/10.1111/iej.12685 (Erratum in: Int Endod J. 2018;51(10):1184. https://doi.org/10.1111/iej.12993)
7. Trope M., Elfenbein L., Tronstad L. Mandibular premolars with more than one root canal in different race groups. J Endod. 1986;12(8):343–345. https://doi.org/10.1016/S0099-2399(86)80035-8
8. Mittal N., Kumar T., Parashar V. Endodontic management of mandibular second premolar with Type-III Vertucci: a rare case. J Clin Diagn Res. 2020;14(4):ZD05–ZD06. https://doi.org/10.7860/JCDR/2020/42484.13625
9. Mittal N., Azeez M.F., Sharma S. Non-surgical management of mandibular first premolar with Vertucci Type V root canal configuration: A case report. IP Indian Journal of Conservative and Endodontics. 2024;9(3):146–149. https://doi.org/10.18231/j.ijce.2024.032
10. Yoshioka T., Villegas J.C., Kobayashi C., Suda H. Radiographic evaluation of root canal multiplicity in mandibular first premolars. J Endod. 2004;30(2):73–74. https://doi.org/10.1097/00004770-200402000-00002
11. Martínez-Lozano M.A., Forner-Navarro L., Sánchez-Cortés J.L. Analysis of radiologic factors in determining premolar root canal systems. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1999;88(6):719–722. https://doi.org/10.1016/s1079-2104(99)70016-8
12. Hajihassani N., Roohi N., Madadi K., Bakhshi M., Tofangchiha M. Evaluation of root canal morphology of mandibular first and second premolars using cone beam computed tomography in a defined group of dental patients in Iran. Scientifica. 2017;2017:1504341. https://doi.org/10.1155/2017/1504341
13. Jain S., Mandke L. The hunt for the hidden – Methods of locating root canals. Int J Oral Health Dent. 2022;8(1):18–22. https://doi.org/10.18231/j.ijohd.2022.005
14. Jacob S. MB2: The floor “Map”, White line test and Red line Test. April 16, 2020. Available at: https://sijuendo.blog/2020/04/16/mb2-white-linered-line-and-the-floor-map/ (accessed: 03.03.2026).
15. Prade A.C., Mostardeiro R.D.T., Tibúrcio-Machado C.D.S., Morgental R.D., Bier C.A.S. Detectability of middle mesial canal in mandibular molar after troughing using ultrasonics and magnification: an ex vivo study. Braz Dent J. 2019;30(3):227–231. https://doi.org/10.1590/0103-6440201802152
16. Khoshbin E., Donyavi Z., Ghaneie S. Endodontic treatment of a mandibular second premolar with three canals and atypical orifices: a case report. Avicenna J Dent Res. 2017;9(4):e28149.
17. Gündüz H., Özlek E., Baş Z. Influence of passive ultrasonic irrigation cycles on the penetration depth of sodium hypochlorite into root dentin. Sci Rep. 2025;15:35213. https://doi.org/10.1038/s41598-025-19716-x
18. Jaha H.S. Hydraulic (single cone) versus thermogenic (warm vertical compaction) obturation techniques: a systematic review. Cureus. 2024;16(6):e62925. https://doi.org/10.7759/cureus.62925
Review
For citations:
Habbachi R., Bagga S., Elleuch W., Sahtout S. Management of a mandibular first premolar with two roots and three canals: a case report. Endodontics Today. 2026;24(2):280-285. https://doi.org/10.36377/ET-0190
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