International Journal of Research and Reports in Dentistry

Successful endodontic treatment relies on accurate diagnosis and thorough management of the entire root canal system, especially in teeth with anatomical variations. Maxillary first premolars are known for their complex root canal morphology, and the presence of three roots and three canals is considered a rare anatomical variation that can present both diagnostic and treatment challenges. Failure to identify such unusual anatomy may result in incomplete debridement and compromised treatment outcomes. This case report describes the nonsurgical endodontic management of a three-rooted maxillary first premolar in a 35-year-old male patient who presented with spontaneous pain in the upper left posterior region. Clinical examination and sensibility tests suggested irreversible pulpitis in tooth #24. During working length determination, an additional root was suspected on radiographic examination and was subsequently confirmed using cone-beam computed tomography (CBCT). Modification of the access cavity to a T-shaped design, combined with 3.5× magnification and careful canal exploration, enabled the identification of three distinct canals—mesiobuccal, distobuccal, and palatal. Cleaning and shaping were carried out using hand and rotary instrumentation with copious irrigation using 3% sodium hypochlorite and 17% EDTA, followed by intracanal calcium hydroxide medication and obturation using BIO C SEALER with gutta-percha. Accurate diagnosis aided by CBCT and careful treatment planning contributed to the successful management of this uncommon anatomical variation.