Rare but Possible: Three Roots with Three Canals in Maxillary First Premolars in Pakistani Subpopulation

Background: The anatomical complexity of maxillary first premolars in root and canal configurations can present challenges in endodontic treatment and extractions. Maxillary first premolars may occasionally have three roots and three canals, affecting treatment outcomes. Therefore, this study was designed to assess the variations in the number of roots and root canals in maxillary first premolars in the Pakistani subpopulation using Cone Beam Computed Tomography. Methods: Using convenient sampling, a cross-sectional study was conducted from January 2023 to January 2024 at Fatima Memorial Hospital. A total of 270 maxillary first premolars were analyzed on 143 CBCTs to identify several roots and canals. Patients aged 13 years and older with premolars having fully erupted and completely formed roots were included. Data was analyzed using SPSS version 23 with a chi-square test to evaluate the differences between genders on both sides. A p-value of ≤ 0.05 was considered statistically significant. Results: A Total of 143 participants were analyzed, having 270 maxillary first premolars. 14.8% (n=40) had one root and one canal, 9.3% (n=25) had one root and two canals, 73.3% (n=198) had two roots and two canals, and 2.6% (n=7) exhibited three roots and three canals. A statistically significant difference (p=0.036) in root and canal morphology was observed between genders, with males showing more variations. Bilateral symmetry was noted in 88.7% (n=127) of cases, with the right side showing a slightly higher prevalence of three roots and three canals (2.96%; n=4). Conclusion: The study highlighted the uncommon but possible occurrence of three roots and three canals in maxillary first premolars, underlining the importance of thorough radiographic evaluation for successful treatment.