06/09/2026
🦷 Two canals in a lower first premolar.👀
A 60-year-old female presented with irreversible pulpitis in the lower left first premolar. On radiographic examination and access opening, the anatomy suggested more than a single canal — not what you'd expect in this tooth. 🔍
📏 Buccal canal negotiated to 24mm, 25/.04 — unusually long for a premolar.
đź“Ź Lingual canal negotiated next, patency achieved, prepped to 23mm, 20/.04.
Both canals converged and exited through a single foramen — a Vertucci Type II configuration. ⚡
Swipe ➡️ for how to catch this before it catches you:
âś… Meticulous preop PA reading
âś… The SLOB rule for separating superimposed canals
âś… The fast break phenomenon as an indication to stop and recalibrate
Two-canal configurations show up in a minority of mandibular first premolars — often missed because nobody was looking for them. đź§
Preserve when possible. Replace when necessary. 🙏
đź’¬ Questions? Drop them below.
