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Review
. 2014;2014:512574.
doi: 10.1155/2014/512574. Epub 2014 May 8.

Endodontic and Clinical Considerations in the Management of Variable Anatomy in Mandibular Premolars: A Literature Review

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Free PMC article
Review

Endodontic and Clinical Considerations in the Management of Variable Anatomy in Mandibular Premolars: A Literature Review

Denzil Albuquerque et al. Biomed Res Int. .
Free PMC article

Abstract

Mandibular premolars are known to have numerous anatomic variations of their roots and root canals, which are a challenge to treat endodontically. The paper reviews literature to detail the various clinically relevant anatomic considerations with detailed techniques and methods to successfully manage these anomalies. An emphasis and detailed description of every step of treatment including preoperative diagnosis, intraoperative identification and management, and surgical endodontic considerations for the successful management of these complex cases have been included.

Figures

Figure 1
Figure 1
Occlusal photograph showing bilateral premolar molarization in the mandibular second premolars (reprinted with permission from Rajesh Ebenezar et al. [6]).
Figure 2
Figure 2
(a) Radiograph in straight angulation. (b) An additional radiograph with a 15–20 degrees horizontal angulation clearly showing a dividing canal.
Figure 3
Figure 3
(a) A sudden change in radiographic density at the coronal third indicates canal bifurcation, which is distinctly visible on an angulated radiograph (b).
Figure 4
Figure 4
Two periodontal ligament spaces on one side of a root (mesially) and a sudden change in the pulpal radio-density point to multiple roots and canals, respectively.
Figure 5
Figure 5
Photographs (a and b) and multiple angulated radiographs (c) of a geminated mandibular first premolar showing the complexity of the internal and external and coronal and radicular anatomy. Multiple canals that fuse and redivide add to the endodontic challenge.
Figure 6
Figure 6
Clinical (a) and radiographic (b) images of a supernumerary fully formed lower bicuspid with an exaggerated linguoocclusal inclination that could add to the endodontic challenge of visibility, access, and instrumentation.
Figure 7
Figure 7
CBCT cross-sectional image of a mandibular first premolar (arrow), showing the spatial relation of a type VIII canal configuration and a deep mesial radicular groove (reprinted with permission from Yu et al. [11]).
Figure 8
Figure 8
Modification of the access cavity in a mandibular premolar to a buccolingually directed oval access for identification and instrumentation of the second canal.
Figure 9
Figure 9
(a) A mandibular second premolar with a missed lingual canal seen distal to the obturated straight buccal canal (white arrow), seen as a mid-root off-shoot at a sharp angle, visualized as a lower letter case “h.” (b) Postretreatment radiograph with obturation of both buccal and lingual canals.
Figure 10
Figure 10
Eccentric bleeding points indicating the presence and location of the buccal canal.
Figure 11
Figure 11
(a) Operating microscopic view showing the clinical trifurcation and the orientation of canal orifices. (b) Postobturation radiograph.
Figure 12
Figure 12
Cross-sectional view at the middle third of a mandibular first premolar tooth showing reduced root dentin thickness (0.5 mm) in relation to the mesiolingual invagination compared to a much wider root thickness of 1.6 mm, buccally. (M) Mesial surface, (D) distal surface, (B) buccal surface, and (L) lingual surface (reprinted with permission from Sandhya et al. [27]).
Figure 13
Figure 13
The cut end of a master cone gutta percha pierced with a number 20 spreader.
Figure 14
Figure 14
(a) Mandibular premolar with an apical third bifurcation, (b) working length radiograph, (c) an ISO 20 K-file is placed in the mesial canal and the master cone in the distal canal, (d) obturation of the distal canal by warm vertical compaction up to the level of the bifurcation, with the file in mesial canal to prevent its blockage, (e) master cone in the mesial canal, (f) warm vertical compaction of mesial and distal canals, and (g) postobturation radiograph.

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