The aim of the study was to report a clinical case of endodontic treatment of a maxillary first premolar with three root canals using an optical microscope and rotary instrumentation technique. The main complaint of the patient, a 16-year-old girl, was pain in tooth 14. After clinical and radiographic examination, irreversible pulpitis was diagnosed. An alteration in the middle third of the pulp chamber radiographically observed suggested the presence of three root canals. Pulp chamber access and initial catheterization using size number 10 K-files were performed. The optical microscope and radiographic examination were used to confirm the presence of three root canals. PathFiles #13, #16, and #19 were used to perform catheterization and ProTaper files S1 and S2 for cervical preparation. Apical preparation was performed using F1 file in the buccal canals and F2 in the palatal canal up to the working length. The root canals were filled with Endofill sealer by thermal compaction technique using McSpadden #50. The case has been receiving follow-up for 12 months and no painful symptomatology or periapical lesions have been found. The use of technological tools was able to assist the endodontic treatment of teeth with complex internal anatomy, such as three-canal premolars. 1. Introduction The constant development of equipment and instrumentation techniques has made it possible to solve several clinical cases in the field of Endodontics [1]. However, it is still imperative that professionals have a thorough knowledge of the internal anatomy of the pulp chamber and the entire root canal system in order to increase efficiency and, consequently, the rate of clinical success of endodontic treatment [2, 3]. Among permanent teeth, the roots of maxillary first premolars often have two conical roots, that is one buccal and one palatal root, which may present root fusion with a distinct line between them [4]. The buccal root may be further divided into two, an incidence of 1% to 5%, which causes the tooth to have three canals, a palatal, a distobuccal, and a mesiobuccal canal [4, 5]. Despite the low incidence, several studies have demonstrated the existence of three-canal maxillary first premolars, which considerably makes endodontic treatment difficult [5]. According to Gondim Jr. et al. [6], diagnosis and treatment of root canals represent an additional challenge for the professional. Thus, a careful examination of preoperative radiographs and the use of computed tomography as an additional diagnostic tool will be important to detect anatomical variations [7, 8].
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