Endodontic Treatment and Restoration of a Mandibular First Premolar Type IV Wiene’s Root Canal Configuration with IPS E.Max CAD Technology: A Case Report

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Knowledgeof the complexity of root canal anatomy and common variants is necessary for the success of root canal treatment. Clinically, it is important to know that a root has a single root canal at the pulp chamber floor that splits into multiple root canals at a certain point of the root canal length; it is also important to determine the level of the root canal where the separation occurs. Root canal spitting in the middle and apical root canal sections may go unnoticed, is more difficult to manage and may affect the cyclic fatigue of endodontic instruments. Weine’s classification system of root canal configuration has long history of use and classified the root canals into four types. Type I is one continuous root canal with one orifice and one exit. Type II is a canal with two orifices which combines into one before reaching the portal of exit. Type III refers to two distinct canals which has two distinct orifices and two distinct portal of exit. Type IV refers to canal which has one orifice and diverges into two canals which has separate portal of exit.

Themain objective of root canal therapy is thorough shaping and cleaning of all pulp spaces and its complete obturation with an inert filling material. The presence of an untreated canal may be a reason for failure. A canal may be left untreated because the dentist fails to recognize its presence. The mandibular premolars are difficult to treat as they have a high flare-up and failure rate. It may be due to the extreme variations in root canal morphology. Normally the root canal system of the mandibular second premolar is wider buccolingually than mesiodistally with two pulp horns. At the cervical line the root and canal are oval; this shape tends to become round as the canal approaches the middle of the root. If two canals are present, they tend to be round from the pulp chamber to their foramen. Another anatomic variation is that a single, broad root canal may bifurcate into two separate root canals. Direct access to the buccal canal is usually possible, whereas the lingual canal may be very difficult to find. The lingual canal tends to diverge from the main canal at a sharp angle. In addition, the lingual inclination of the crown tends to direct files buccally, making location of a lingual canal orifice more difficult.