The Easy Ones

The Easy Ones:
Many practitioners assume that molars are the most complex teeth with regards to their internal anatomy. However, the most variable of all teeth in the oral cavity are mandibular first premolars. This case demonstrates a seemingly quality RCT (arguably an unnecessary post) in terms of fill and length. This patient presented with severe facial swelling, grade 3 mobility, and incredibly pain following recent RCT #28 completed by an emergency dentist (not their usual dentist). After removal of the post, several additional canals were located in an apical split. Due to the severity of the infection and grade 3 mobilitiy, a surgical flap was elevated for debridement, the teeth were splinted, and calcium hydroxide was placed to disinfect this unusual anatomy for several weeks. This patient returned asymptomatic and the splint was removed to demonstrate physiologic mobility only. Obturation material was placed and the patient returned to their dentist for final restorative treatment. An interesting reminder that the seemingly easy mandibular premolar can bifurcate >15% of the time (granted, this trifurcated tooth is quite rare!).