Clinical management of molarized premolars with three canals

Introduction: Molarized premolars with three root canals represent a rare anatomical variation that can complicate endodontic treatment. Failure to recognize additional canals is a common cause of treatment failure.
Objective: The aim of this paper is to describe the clinical management and key considerations in the endodontic treatment of molarized premolars with three canals.
Materials and Methods: This study is based on established clinical guidelines and is complemented by the presentation of selected clinical cases. Diagnostic procedures included comprehensive clinical examination and periapical radiographic assessment. The use of magnification devices, particularly an operating microscope, was emphasized to enhance diagnostic accuracy and treatment precision. Standardized endodontic protocols were followed, including access cavity preparation and mechanical instrumentation using nickel–titanium rotary files. Chemical irrigation was performed with sodium hypochlorite and ethylenediaminetetraacetic acid to ensure effective canal disinfection. Obturation was carried out using a bioceramic sealer in combination with gutta-percha cones to achieve a hermetic seal of the root canal system.
Results: Accurate diagnosis combined with proper access cavity design improves the detection of all canals. The use of modern instruments and irrigation protocols enables effective cleaning and shaping of complex canal systems, leading to successful obturation and improved treatment outcomes.
Conclusion: Successful management of molarized premolars with three canals requires thorough knowledge of root canal anatomy, careful diagnosis, and the use of advanced endodontic techniques and technologies.