Endo-Perio management of maxillary first premolar with three distinct roots and three canals diagnosed with Cone Beam Computed Tomography-A rare case report

Many of the difficulties found in endodontic therapy are caused by variations in root canal anatomy. Any pre-assumptions regarding the root canal morphology will eventually lead to endodontic failure. Maxillary first premolars show a considerable variation in root canal morphology but the presence of three roots is rare. The incidence shown in the literature for three rooted maxillary first premolar is 0.5 to 6%. Endodontic-periodontal lesions offer a constant challenge to the clinician for diagnosis, treatment and prognosis. Treatment and prognosis of endodontic-periodontal diseases vary depending on the cause and the correct diagnosis of each specific condition. Management of such lesions needs a multidisciplinary approach. Use of three dimensional imaging technology like Cone Beam Computed Tomography (CBCT) has proven to be an essential tool for successful diagnosis of such lesion and higher magnification using the Dental Operating Microscope (DOM) should always be given preference during the clinical procedure. This case report describes the treatment performed on a maxillary first premolar having three independent roots and three distinct root canals with furcation involvement. Special care needs to be taken during clinical examination, refining the access cavity, locating the orifices of the root canals on the pulpal floor and cleaning, shaping and obturating all identified root canals. The tooth was successfully managed by conventional endodontic treatment and regenerative periodontal surgical intervention.