A Premolar Bifurcation – Tooth #34

Products: ProTaper Gold files up to size F4 for the B canal and TRUShape file up to size #25 for the L canal.

According to Cleghorn et al. review paper (JOE, 2007), the incidence of 2 roots in the mandibular first premolar is 1.8%. This is one reason why I thought to share this rare case. The main reason however, is because I learned a lot from this case regarding how to locate “a hidden orifice”, and hot to instrument a canal “without a straight line access”. Moreover, I learnt how to “trust my rotaty instruments” because in this case, the working length of the Lingual canal was reached only after a Trushape file (20/.06) was used. (With the K hand files the working length and the glide path that was established up to size 20, was 1.5mm shorter than the working length for the L canal)
The diagnosis for the tooth #44 was: previously initiated with chronic apical abscess. The patient presented with his chief complaint to be related to the presence of the sinus tract. During the clinical examination the tooth found to be sensitive to palpation, percussion and bite test. Advantages and disadvantages of the treatment options and the need of a permanent restoration were discussed. The patient decided to proceed with the RCT. The Lingual root was bifurcated at the depth of 16mm, with a Distal-Lingual direction.

Name: Eleni Irinakis

University: University of British Columbia

Pre-Op Radiograph

Post-Op Radiograph

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