One Case Of Maxillary Premolar Treated With Four Canals

Report a case of four canals with accessory root canal variations in the upper left first premolar. A 48 year old male presented with spontaneous pain in the upper left first premolar(24). The root apex film indicated that the images of the middle section of 24 canals were unclear and not centered. Further CBCT revealed that there were four canals in 24 with the palatal, mesial, distal buccal, and accessory root canals.The shadow in the root bifurcation area indicated the presence of the accessory root canal apex. The diagnosis was pulpitis accompanied by periapical periodontitis in 24. Root canal treatment was recommended for the patient, although the difficulty of treating the canals was assessed as high. Treatment involved shaping root canals under DOM. Three main root canals were obturated with warm vertical condensation technique, while the accessory root canal iRoot BP formed a apical barrier. After 9 months of follow-up, good treatment outcomes were observed, and CBCT showing a reduction in the shadow area of the root bifurcation. selective inlay repair was performed. It is important to note that infections in the root bifurcation area, where the accessory root canal is located, require careful attention during root canal treatment. Thorough debridement and tight closure of the secondary root canal are essential to prevent the worsening of infections and the development of periodontitis in this area. In conclusion, combining CBCT with DOM for root canal treatment can lead to successful outcomes in complex cases like this one.