Endodontic treatment of a mandibular premolar with Vertucci type V root canal morphology: a rare case report

Abstract

A thorough understanding of the root canal morphology and correct evaluation of preoperative radiographs are essential for endodontic treatment. As many cases of endodontic treatment failure are due to missed canals, clinicians should be aware of all types of variations that may exist in the root canal system of each tooth.[1] Vertucci [2,3] (2005) classified morphological patterns of the root canal systems into eight types. In the simplest form, each root has a single canal and a single apical foramen (type I). However, other canal complexities that exit the root as one, two, or more apical canals (types II-VIII) exist. [2,3] In general, the mandibular second premolars have a single root and a single canal (Vertucci type I; 99.28% and 86.9%, respectively).[4] However, the incidence of a single root with two canals (Vertucci type V) in the mandibular second premolars is very rare (6.4%-29%). [5,6] Treatment failures and post-treatment flare-ups have been reported in these teeth, thus indicating too much variation in the morphology of mandibular second premolars. [7,8] To date, only a few retreatment cases of mandibular second premolars with one root and two canals have been reported in the literature. [9] This case report describes the successful retreatment of an unusual mandibular second premolar with Vertucci type V root canal morphology. Case reportA 39-year-old female patient was referred by her general dentist to the Istanbul Medipol University, Faculty of Mandibular premolars have been reported with complex anatomical aberrations, making endodontic treatment of these teeth extremely difficult. A case of endodontic retreatment of a mandibular second premolar exhibiting root canal bifurcation (Vertucci type V root canal configuration) of two apical foramina was described. A 39-year-old female with a non-significant medical history presented with a chief complaint of pain in a previously endodontically treated tooth. Clinical examination revealed tenderness to percussion. Intraoral periapical radiographs taken at different angulations revealed one root and two apical foramina. The main root canal was filled short of the apex and the other canal was not filled due to the broken file. Root canal retreatment was performed following the standard protocols. Although the prevalence of one root and two apical foramina in mandibular premolar is very low, clinicians should always be aware of variations in the number of roots and canals for the proper management of such cases.