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Mandibular premolars exhibit intricate and diverse root canal anatomy, presenting substantial challenges in endodontic treatment. Uncommon variations, such as the presence of three canals, demand meticulous diagnostic and therapeutic approaches to mitigate the risk of overlooking canals and subsequent treatment failure. This case report highlights three cases of mandibular premolars exhibiting a rare root canal configuration with one mesial and two distal canals, successfully managed using cone beam computed tomography (CBCT) for accurate diagnosis and ultrasonic activation for disinfection. The findings underscore the significance of utilizing three-dimensional imaging and precise canal identification in addressing anatomical anomalies in mandibular premolars, which have been sparsely documented in the existing literature. This report aims to contribute to understanding and managing the rare and complex root canal configurations in endodontics., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, A et al.)

Introduction and Aim:  Root canal therapy is a vital procedure for saving teeth by removing infection and cleaning the complex root canal system. However, a delicate balance exists between thorough cleaning and preserving tooth strength. The study aims to evaluate the instrumentation effect of three innovative file systems, XP-endo® shaper, Reciproc®, and Self-adjusting file (SAF) on fracture resistance of mandibular premolars., Materials and Methods: Thirty single-rooted mandibular premolars were collected; a standard access cavity was prepared and the working length was established 1 mm short of the apex. The teeth were randomly divided into three groups(n=10). In Group 1, the shaping of the specimens was achieved using XP-endo® shaper; in Group 2, it was instrumented using Reciproc® file; and in Group 3, it was instrumented using SAF. All samples were decoronated and the roots were mounted vertically in acrylic resin and subjected to fracture resistance under a universal testing machine., Results: Intergroup analysis was done by one-way ANOVA followed by Bonferroni post hoc test, which did not report a statistically significant difference (p>0.05)., Conclusion: All three tested file systems were similar in fracture resistance. XP-endo® shaper exhibited better fracture resistance on root canal instrumentation when compared to Reciproc® and SAF although they are not statistically significant., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Institutional Ethics Committee at Kamineni Institute of Dental Sciences, Nalgonda issued approval KIDS/IEC/2024/401. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, P et al.)

Aim: This study aimed to evaluate root number and morphological variations of the root canal system in maxillary and mandibular premolars among the Saudi subpopulation., Methodology: A total of 500 cone-beam computed tomography (CBCT) images were assessed, including 2442 maxillary and mandibular premolars. The evaluation encompassed the number of roots and canals and their configuration based on the Vertucci classification. Gender differences were considered, along with the position of premolars and unilateral or bilateral symmetry., Results: Maxillary first premolars predominantly exhibited two roots (82.6%), followed by one root (16.3%) and three roots (0.97%), with a majority having two root canals (83.6%). Regarding maxillary second premolars, the most common morphology was one root (66.6%), with two root canals (40.5%) observed more frequently than one root canal (38.1%). Mandibular first and second premolars mainly featured one root (84.8% and 96.1%, respectively) with one root canal (70.8% and 90.2%, respectively), whereas two root canals were less prevalent (2.3% and 1.8%, respectively). Three canals and three roots were rarely found in mandibular premolars (0.3%). Regarding maxillary premolars, males exhibited significantly higher type IV and mandibular type I root configurations compared with females. Conversely, regarding mandibular premolars, females showed significant mandibular type V and higher type I root configurations compared with males., Conclusion: CBCT imaging facilitated precise assessment of root morphology and root canal configurations in maxillary and mandibular premolars. The present findings can aid dentists in diagnosing, evaluating case difficulty, and devising effective root canal treatments, particularly in patients from Saudi Arabia., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Mirah et al.)

Background/purpose Root fractures after endodontic treatment are a serious complication, and it often causes tooth loss, several studies have found a correlation between root canal preparation and filling, and the possibility of root fracture. Therefore, this study aimed to evaluate the root fracture resistance of the endodontically treated mandibular premolars after preparing and filling by EndoSequence Bioceramic (BC), EndoSequence BC HiFlow, and AH Plus (AHP). Materials and methods The study sample consisted of 75 single-rooted and single-canal mandibular premolars, they were randomly distributed into five groups: Group I: root canals preparation and fillings with AHP sealer; Group II: root canals preparation and fillings with EndoSequence BC sealer; Group III: root canals preparation and fillings with BC HiFlow sealer; Group IV (Negative Control): without root canals preparation; and Group V (Positive Control): canals preparation without root canals filling. A glide path was established by #10 hand K-file, then the crowns were cut, and the canals were prepared and filled. All teeth were restored with glass ionomer cement and kept in an incubator at 37°C for a week. All samples were placed within acrylic bases and a vertical force was applied using a Testometric machine and the fracture resistance force was recorded. Results EndoSequence BC and BC HiFlow groups showed slightly better fracture resistance (494.440, 496.960 N respectively) than AHP group (492.680 N). However, no statistically significant difference was found between the two groups (P-value >0.05). The greatest mean fracture force was observed in the positive control group (736.040 N) with statistically significant difference between the other groups (P-value <0.01) and the least mean fracture force was shown in the negative control group (318.040 N) with statistically significant difference between the other groups (P-value <0.01). Conclusion Based on this in vitro study, the use of EndoSequence BC, BC HiFlow, and AHP enhanced the fracture resistance in root-filled single-rooted premolar teeth. While, the application of EndoSequence BC, BC HiFlow, and AHP did not increase the fracture resistance of roots compared to that of unprepared root canals., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2022, Abdulsamad Alskaf et al.)