Diagnostic and Treatment Considerations

• Radiographic difficulties: Moderate difficulty interpreting radiographs
• Canal & root morphology: Mandibular premolar with two roots
• Radiographic appearance of canals: Indistinct canal path

Preoperative evaluation and clinical testing supported a diagnosis of pulpal necrosis with symptomatic apical periodontitis. Conventional radiography displayed a mandibular premolar with atypical root morphology. Further study using Cone Beam Computerized Tomography (CBCT) disclosed the presence of a horizontal root fracture.

All other considerations aside, the presence of a mandibular premolar with two roots would have made endodontic treatment very difficult. However, the additional diagnostic information obtained by the CBCT helped to determine
a more appropriate treatment plan (extraction) avoiding endodontic failure and further complications.