# Endodontic management of maxillary premolars with three roots: a case series

## TL;DR

This paper presents three cases of rare three-rooted maxillary premolars and highlights the use of advanced imaging and techniques for successful endodontic treatment.

## Contribution

The study demonstrates the clinical application of CBCT and magnification in managing complex three-rooted maxillary premolars.

## Key findings

- CBCT imaging was essential for identifying complex root canal anatomy in three-rooted maxillary premolars.
- Ultrasonic tips and magnification improved access and detection of additional canals.
- Successful treatment outcomes were achieved through advanced diagnostic and clinical techniques.

## Abstract

Three-rooted maxillary premolars represent rare anatomical variations that pose significant diagnostic and clinical challenges in endodontic treatment. Failure to recognize additional roots or canals increases the risk of persistent infection and treatment failure. This case series describes the diagnostic approach and clinical management of maxillary premolars with complex three-rooted anatomy, emphasizing the importance of advanced imaging and magnification in achieving successful treatment outcomes.

Three patients were referred for endodontic evaluation of maxillary premolars with suspected complex anatomy. Clinical examination, pulp testing, and periapical radiographs were supplemented with cone beam computed tomography (CBCT). All three cases exhibited distinct three-rooted morphology, with CBCT scans proving essential for identifying bifurcations, confluence, and previously missed canals. Access cavity modification with ultrasonic tips facilitated straight-line access and detection of additional canals. Chemo-mechanical preparation was performed with 2% sodium hypochlorite and 17% ethylenediaminetetraacetic acid using rotary instruments. Following obturation, postoperative radiographs were taken to verify treatment quality.

This case series emphasizes the importance of recognizing anatomical variations in maxillary premolars. It also demonstrates the essential role of CBCT imaging and magnification in the diagnosis and management of complex root canal systems.