Endodontic Treatment and Restoration of a Mandibular First Premolar Type IV Wiene’s Root Canal Configuration with IPS E.Max CAD Technology: A Case Report

Case Report

Austin J Dent. 2018; 5(5): 1115.

Endodontic Treatment and Restoration of a Mandibular First Premolar Type IV Wiene’s Root Canal Configuration with IPS E.Max CAD Technology: A Case Report

Talabani RM¹*, Rassam R² and Omer JO³

¹Department of Conservative Dentistry, College of Dentistry/University of Sulaimani, Iraq

²Specialist of Esthetic Dentistry and Implantology in B&R Dental Center, Iraq

³Digital Designer in Fixed Prosthodontic CAD/CAM Technology in B&R Dental Center, Iraq

*Corresponding author: Talabani RM, Department of Conservative Dentistry, College of Dentistry/ University of Sulaimani, Kurdistan Region, Sulaimani-Dream Land B-25, Iraq

Received: March 28, 2018; Accepted: April 04, 2018; Published: April 24, 2018


This case report describes an endodontic treatment of a mandibular first premolar with type IV root canal. A 28-year-old male patient reported pain in left mandibular first premolar. Clinical examination showed a large carious lesion with pulp exposure. Radiograph showed no periapical change with intact periodontal ligament space. Mandibular first premolars usually have one canal. The mandibular first premolar may present large number of anatomic vibrations. The clinician should be aware of the configuration of the pulp system. This case presents the diagnosis and clinical management of a mandibular first premolar with two distinct canals in the apical third of root (Type IV Wiene’s canal configuration), drawing particular attention to tactile examination of all canal walls and preparation with wave.one gold reciprocating system then obturating it with single cone and AH Plus sealer and finally restored with fiber post and IPS E.Max Cad/Cam technology.

Keywords: Mandibular first premolar; Canal configuration; Fiber post; CAD/ CAM


Knowledge of the complexity of root canal anatomy and common variants is necessary for the success of root canal treatment [1].

Clinically, it is important to know that a root has a single root canal at the pulp chamber floor that splits into multiple root canals at a certain point of the root canal length; it is also important to determine the level of the root canal where the separation occurs. Root canal spitting in the middle and apical root canal sections may go unnoticed, is more difficult to manage and may affect the cyclic fatigue of endodontic instruments [2].

Weine’s classification system of root canal configuration has long history of use and classified the root canals into four types [3]. Type I is one continuous root canal with one orifice and one exit. Type II is a canal with two orifices which combines into one before reaching the portal of exit. Type III refers to two distinct canals which has two distinct orifices and two distinct portal of exit. Type IV refers to canal which has one orifice and diverges into two canals which has separate portal of exit.

The main objective of root canal therapy is thorough shaping and cleaning of all pulp spaces and its complete obturation with an inert filling material. The presence of an untreated canal may be a reason for failure. A canal may be left untreated because the dentist fails to recognize its presence [4].

The mandibular premolars are difficult to treat as they have a high flare-up and failure rate. It may be due to the extreme variations in root canal morphology. Normally the root canal system of the mandibular second premolar is wider buccolingually than mesiodistally with two pulp horns. At the cervical line the root and canal are oval; this shape tends to become round as the canal approaches the middle of the root. If two canals are present, they tend to be round from the pulp chamber to their foramen. Another anatomic variation is that a single, broad root canal may bifurcate into two separate root canals. Direct access to the buccal canal is usually possible, whereas the lingual canal may be very difficult to find. The lingual canal tends to diverge from the main canal at a sharp angle. In addition, the lingual inclination of the crown tends to direct files buccally, making location of a lingual canal orifice more difficult [5].

After root canal treatment, the teeth become weakened due to structural loss that results from canal preparation or extensive previous restoration. That is why they require specialized restoration materials. The use of intracanal posts, especially fibre posts, promotes both the retention of the final restoration and the strengthening of the remaining tooth structure the elasticity of the fibre post is very similar to dentine, and because of this, prevents vertical fracture risk by distributing the stress from the canal walls [6].

Endodontically treated tooth mainly weakened due to dental caries, trauma, or pre-existing restorations. Tooth fracture usually occurs when the root filled tooth is not immediately or properly restored, success rate in endodontically treated tooth with immediate permanent restorations is higher than those with longterm provisional restorations, especially in the posterior teeth with excessive loss of tooth structure [7].

Computer aided design/computer aided manufacturing (CAD/ CAM) systems are widely used in dentistry. CAD/CAM ceramic materials are manufactured under optimized conditions, which can minimize the voids and volume defects. Among the materials used in all-ceramic restorations, lithium disilicate glass ceramic (IPS e.max CAD, IvoclarVivadent) not only exhibits a favorable translucency and shade variety, but also has a greater flexural strength [8].

This case report describes the successful diagnosis and treatment of mandibular first premolar with a Type IV Weine’s configuration.

Case Presentation

A 28-year-old male with a noncontributory medical history sought treatment at B&R private Dental Center. Chief complaint was “pain at night”. Clinical examination showed a large class II carious lesion with pulp exposure. The tooth was sensitive to cold testing. Investigation for swelling, sinus tract, and periodontal involvement were negative; the pulp was diagnosed as symptomatic irreversible pulpitis. Preoperative panoramic radiograph revealed no any periapical change and intact periodontal ligament space (Figure 1).