Dr. Osama Elmowafi
South Africa
This advanced complex endodontic case involves a molarized maxillary premolar (tooth 24) presenting with three separate roots and canals. Such anatomical variations demand careful planning, precise execution, and a controlled restorative approach to achieve predictable outcomes.
Case Overview
Tooth 24 was diagnosed as requiring endodontic treatment. The key anatomical challenge was the presence of three distinct roots and canals with the following working lengths:
- Palatal root: 26.5 mm
- Mesiobuccal root: 23.5 mm
- Distobuccal root: 23 mm
In addition to the multi-rooted configuration, clinical access was complicated by a deep mesial gingival margin and a narrow, deep palate. These factors made both isolation and periapical radiography more difficult than in routine cases.
Clinical Challenges
Molarized maxillary premolars can conceal extra canals, underscoring the need for thorough anatomical awareness before initiating access. The combination of a deep mesial gingival margin and restricted palatal anatomy required meticulous isolation to maintain a dry, controlled field throughout the procedure.
Clinical Workflow
The treatment followed a structured sequence:
- Isolation
Rubber dam isolation was achieved with the aid of liquid dam. Access remained challenging due to the anatomical constraints, yet a secure seal was obtained. - Access and Canal Location
All three canals were successfully located. - Instrumentation
Shaping was performed using the Rogin EZ-Shaper Pro system. The system adapted effectively to the three distinct root lengths ranging from 23 mm to 26.5 mm. - Obturation
The canals were obturated with ENP NrootSP bioceramic sealer, chosen for its ability to support a reliable seal in a complex multi-canal configuration. - Restoration
The final restoration was completed under continued rubber dam and liquid dam isolation using a layered composite approach:- GC EverX Flow
- GC G-aenial Injectable composite
- GC G-aenial Packable composite
Clinical Tips
- Always maintain strong anatomical awareness when treating molarized premolars, as extra canals are frequently present.
- Deep gingival margins combined with a narrow, deep palate require meticulous isolation techniques.
- The Rogin EZ-Shaper Pro system can be adapted successfully across varying root lengths (23–26.5 mm) in multi-rooted premolars.
- Bioceramic sealers such as ENP NrootSP provide reliable sealing capacity in complex multi-canal anatomies.
Conclusion
This complex endodontic case of a molarized maxillary premolar (tooth 24) highlights the critical role of anatomical awareness, precise instrumentation, effective obturation, and a controlled restorative protocol. Successful management of three separate roots under challenging isolation conditions demonstrates how careful attention to detail supports predictable outcomes in advanced endodontic treatment.
