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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.)

Teeth may exhibit a wide range of anatomical variations in their roots and root canal systems, making them challenging to treat in endodontic procedures. Generally, maxillary canines and mandibular premolars present with a single root with one canal, and variations are comparatively rare. Achieving a fluid-impervious seal in endodontic therapy requires thorough debridement and three-dimensional obturation of the root canal system, which is considered a complex micro-neurologic procedure. Clinicians may fail to achieve the successful outcome without a comprehensive understanding of the pulp chamber and root canal system anatomy. We present a report of successful management of previously failed root canal treatment of two such cases, a maxillary canine and a mandibular premolar, with a previously missed second canal due to their uncommon root canal morphological presentation. This report also comprehensively reviews the literature, focusing on the clinically significant anatomical variations and detailing techniques for the effective management of such anomalies in endodontic treatment. The review provides an in-depth explanation of each stage of treatment, including preoperative diagnosis, intraoperative identification of morphological variations, and evidence-based modern endodontic treatment approaches. Emphasis is placed on ensuring a thorough understanding of these steps to achieve successful outcomes in the management of complex cases involving root canal anatomical variations., 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, AlTamimi et al.)

To achieve success in endodontic treatment, it is essential to have a thorough understanding of the root and canal morphology. While maxillary canines typically have a single root and canal, studies have reported variations in different populations. This case report details the non-surgical endodontic management of a maxillary canine (tooth no. 13) with a Vertucci type 3 canal configuration in a 69-year-old female patient. The patient reported pain in the maxillary right canine (#tooth no. 13) and was diagnosed clinically with apical periodontitis. The patient's dental history revealed an ameloblastoma in the right mandibular region, successfully treated five years ago. Cone beam computed tomography aided the treatment. After completing the root canal treatment (#13) involving the two canals, an incidental loop-type accessory canal was noted. After three years of follow-up, the patient reported being asymptomatic. This paper reports the endodontic management of an uncommon type 3 canal configuration in the maxillary canine. Clinicians must remain aware of canal variations and utilize modern diagnostic tools like cone beam computed tomography to ensure all canals are located and adequately treated., 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, Gehlot et al.)

Mandibular lateral incisors sometimes feature an additional lingual canal, which, if not identified and missed during endodontic treatment, can lead to postoperative pain. Thus, a proper diagnosis of the internal anatomy of a tooth is necessary before treatment begins. Radiovisiography (RVG), a cost-effective and widely employed dental imaging technique, is used in clinics to visualize the internal root structure of teeth. The zoom function of RVG allows for a detailed examination of complex internal anatomical variations, facilitating a more accurate diagnosis and treatment planning process. This case study identified a rare Vertucci Type VII root canal system in a mandibular left lateral incisor using the zoom-in feature of radiovisiography (Vatech, EZ sensor). Additionally, horizontal sectioning was performed, and these sections were imaged to verify the accuracy of digital radiographs in diagnosing such cases as part of a preclinical demonstration for aspiring endodontists., Competing Interests: Human subjects: Consent 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, Jethi et al.)

Background Understanding root canal anatomy variations, particularly C-shaped canals, is crucial for successful endodontic treatment. This study used clinical and radiographic methods to assess the prevalence and characteristics of C-shaped canals in mandibular second molars in Western Maharashtra. Materials and methods This prospective study was conducted in the western region of Maharashtra, India. The samples included patients requiring endodontic treatment for mandibular second molars. Clinical evaluation was conducted using a surgical endodontic microscope and cone beam computed tomography (CBCT) imaging. Inclusion and exclusion criteria ensured the selection of a focused and homogeneous sample. Data analysis included assessment of unilateral/bilateral occurrence, canal distribution, and cross-sectional characteristics. Results Out of 200 mandibular second molars, 7.5% exhibited C-shaped root canals, with no significant gender differences. Canal distribution varied across coronal, middle, and apical levels, with prevalent configurations being C1, C2, C3, and C4. No significant differences were observed in canal distribution based on root levels. No significant gender differences were found in the presence of grooves on the root surfaces. Conclusion This study provides valuable insights into the prevalence and characteristics of C-shaped canals in mandibular second molars in Western Maharashtra. Further research into histological and genetic aspects can enhance our understanding, leading to improved treatment strategies for complex root canal anatomy variations., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ethical Committee of Krishna Institute of Medical Sciences, Deemed University issued approval KIMSDU/DR/573. 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, Shaikh et al.)

This is a unique case of a single-rooted maxillary premolar with two separate canals in bayonet or S-shaped radicular anatomy undergoing post-endodontic reinforcement prior to crown placement. Bayonet-shaped canals present challenges in canal negotiation, cleaning, shaping, and obturation. The complexity of these canals heightens the risk of accidental file breakage and other iatrogenic errors, posing significant challenges. Post-endodontic restoration in S-shaped canals with double curvature poses challenges in precise placement and material adaptation. A novel technique was implicated to preserve the functionality and structural aesthetics of a decayed maxillary first premolar tooth., Competing Interests: Human subjects: Consent 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, Jethi et al.)

The description of non-surgical retreatment is to eliminate all previous filling materials and correct any mishaps. An adequate understanding of root and canal morphology is a fundamental requirement for obtaining a favorable outcome in endodontic treatment. The endodontic diagnosis was previously treated through therapy with symptomatic apical periodontitis. Treatment was performed under a dental operative microscope. Gates Glidden (GG) drills size 2 and 3 were used to remove the coronal part of gutta-percha for all canals. A braiding technique with a Hedstrom file size 15 without a solvent was used to remove gutta-percha and separate the file together for the palatal canal whereas the mesiobuccal canal was retreated by ProTaper Retreatment Kit. Proper understanding of root canal morphology and using an endodontic armamentarium could reduce endodontic mishaps. This case report described the successful management of overextended gutta-percha, a separated file, and a missed canal., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Alnassar et al.)

Introduction: A simple tooth extraction method usually involves using elevators and forceps to remove the tooth easily. In contrast, a surgical extraction method requires utilizing a straight handpiece to facilitate the tooth extraction, either removing bone or sectioning the tooth into pieces., Objective: In this research, we aim to diagnose a tooth radiographically before extraction and determine certain factors to observe which extraction method might be more feasible, either simple or surgical., Methodology: This study followed a retrospective cross-sectional study design. The x-ray radiographs (periapical (PA) or panoramic) were collected from the R4 system in the university dental hospital for data collection. Different radiographic influencing factors were measured, such as bone density, bone level, endodontic involvement (RCT/post and core), crowned or remaining root, and root morphology. Statistical associations were performed using SPSS (IBM Corp., Armonk, NY) with a one-way ANOVA test., Results: There were 62 cases with 47 simple and 15 surgical extractions. There was a non-significant (p>0.05) association between the measured factors and the extraction method, either simple or surgical tooth extraction. Although bone density measurements showed a slight tendency toward PA lesions and simple tooth extraction., Conclusion: There was no significant association between the factors and extraction methods. Future research is required to determine whether or not preoperative radiographic evaluation can influence the decision for the tooth extraction method., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Darwish et al.)

Background The aim of this study was to assess the root morphology of mandibular molar teeth using cone‑beam computed tomography (CBCT) in patients with periodontal disease. Methods In total, 88 patients were included in this study (70 patients with periodontitis and 18 patients with non-periodontitis). This cross-sectional study involved CBCT images taken for patients who visited the dental clinic of Imam Abdulrahman Bin Faisal University (IAU) from January 2019 to March 2021. The following data were analyzed on the mandibular molars: root length, number of root canals, root trunk, distance between roots, accessory canals in the furcation area (ACF), bone loss, and furcation involvement. Results The mesial root was longer than the distal root in the mandibular molars of periodontitis and non-periodontitis patients. A statistically significant difference was observed between non-periodontitis and periodontitis patients regarding the number of mesial root canals of the mandibular first molar; 70% had two root canals in non-periodontitis patients, compared with 86.1% in periodontitis patients (p = 0.04). First molars of non-periodontitis patients had significantly longer root trunks than periodontitis patients (4.65 ± 0.90 compared with 4.09 ± 1.02, p = 0.007). There was a statistically significant difference in bone loss between non-periodontitis and periodontitis patients (0% and 25% for first molars, and 2.8% and 23.6% for second molars, respectively). Accessory furcation canals were 2.9 % in second molars and 7.1 % in first molars in periodontitis patients, which were higher compared with non-periodontitis patients. Conclusions The first molar showed a longer root trunk in non-periodontitis patients than in periodontitis patients. The mean mesial and distal root lengths were also greater in the first than the second molar. Accessory canals in the furcation area were more observed in first molars than in second molars in periodontitis patients compared with non-periodontitis patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2021, Madi et al.)