JICDRO is a UGC approved journal (Journal no. 63927)

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CASE REPORT
Year : 2013  |  Volume : 5  |  Issue : 1  |  Page : 24-26

Endodontic management of mandibular canine with two canals


1 Department of Conservative Dentistry and Endodontics, Subharti Dental College, Meerut, Uttar Pradesh, India
2 Himachal Institute of Dental Sciences, Paonta Sahib, Himachal Pradesh, India

Date of Web Publication9-Jun-2014

Correspondence Address:
Nidhi Shrivastava
Department of Conservative Dentistry and Endodontics, Subharti Dental College, NH-58, Delhi-Haridwar Bypass, Meerut - 250 005, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2231-0754.134133

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   Abstract 

Endodontic treatment may sometimes fail because morphological features of the tooth adversely affect the treatment procedures. Many investigators have reported the anatomical variations associated with mandibular canines. Mandibular canines are recognized as usually having one root and one root canal in most cases. This case report describes a clinical case of mandibular canine with two canals. Human mandibular canines do not present internal anatomy as simple as could be expected; there are such canines with a single root and two canals, two roots or fused roots. The existence of mandibular canines with more than one root canal is a fact that clinicians ought to keep in mind, in order to avoid failure during endodontic treatment. In spite of the low incidence of lower canines with one root and two canals, this possibility cannot be forgotten, inasmuch as the presence of a second canal in these teeth leads to difficulties in endodontic treatment. The precise knowledge of the dental endocanalicular system's anatomy is essential in the success of the root canal therapy, because the failure to detect the accessories canals and the incomplete radicular obturation leads to the infection of the periapical space, which will ultimately result in the loss of the tooth.

Keywords: Anatomy, endodontics, mandibular canine, two canals


How to cite this article:
Shrivastava N, Nikhil V, Arora V, Bhandari M. Endodontic management of mandibular canine with two canals. J Int Clin Dent Res Organ 2013;5:24-6

How to cite this URL:
Shrivastava N, Nikhil V, Arora V, Bhandari M. Endodontic management of mandibular canine with two canals. J Int Clin Dent Res Organ [serial online] 2013 [cited 2019 Jul 19];5:24-6. Available from: http://www.jicdro.org/text.asp?2013/5/1/24/134133


   Introduction Top


The aim of endodontic treatment is the elimination of infection from the root canal and the prevention of reinfection. [1] However, root canal treatment may fail because of factors including persistent infection of the root canal, unsatisfactory intracanal procedures that may lead to poor canal preparation, broken instruments and incomplete root canal fillings. Morphological features of the tooth may also adversely affect endodontic procedures. [2] Many clinicians have the perception that a given tooth will contain a specific number of roots and/or canals. Careful evaluation of research material has, however, shown that variations in tooth morphology are common. Many investigators have reported on the anatomical variations associated with mandibular canines. [3],[4] The following clinical report describes endodontic treatment of one mandibular canine with two canals.


   Case report Top


A 25-year-old patient presented with severe pain in the lower right mandible. The diagnostic radiograph showed restored 43 and obturated 44 [Figure 1]. The restoration in the canine was placed on the pulp chamber and the tooth was symptomatic and severely tender on percussion. On careful evaluation of the diagnostic radiograph, it was seen that in the mandibular canine two canals were present. Local anesthesia was administered and rubber dam was placed. Access was achieved using a round diamond bur. The two orifices were located one buccal and one lingual [Figure 2]. Working length was established radiographically for both canals [Figure 3]. Chemo mechanical preparation was performed using ProTaper File system (Dentsply-Maillefer, Ballaigues, Switzerland) in crown down manner. A 5.25% solution of sodium hypochlorite and 17% ethylenediaminetetraacetic acid were used alternatively as irrigants at every change of instrument. The apical preparation was done until F2 file size in both the canals and the canals were obturated with corresponding ProTaper cones. Postobturation radiograph was recorded [Figure 4].
Figure 1: Preoperative radiograph

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Figure 2: Buccal and lingual orifi ces

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Figure 3: Working length radiograph

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Figure 4: Obturation radiograph

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   Discussion Top


Knowledge of anatomic variations is essential because endodontic success is related to a thorough debridement of the root canal system. There are many studies in favor of multiple visit root canal treatment than single visit as the placement of antibacterial dressing is essential for eradicating all infections from the root canals. However, few recent studies have advocated the treatment of teeth with apical periodontitis in single visit. Kvist et al. [5] observed no statistically significant difference between the groups of teeth with apical periodontitis treated with either single or multiple visit approach. Thus, the tooth was managed in one visit endodontics.

Mandibular canines are recognized as usually having one root and one root canal in the majority of cases. It has been reported that 15% of mandibular canines presented with two canals with one or two foramina. [6],[7]

There was a mention of a case of a mandibular canine that had two roots and three radicular canals. [8] There is also evidence of even three canals with only two apexes, [9] but also of two roots with two separate canals. [10]

Successful and predictable endodontic treatment requires knowledge of biology, physiology and root canal anatomy. It also requires proper instruments and the knowledge to use these instruments effectively. Teeth with extra roots and/or canals pose a particular challenge. Inability to identify and treat these additional root canals may cause treatment failures.

Careful examination of preoperative radiographs can aid in locating additional canal or roots. Thus, root canal therapy of these teeth should be carried out by using X-rays from different angulations, efficient explorers, wider access openings, adequate illumination and whenever possible, image magnification. Necessary precautions have to be taken during root canal therapy of these teeth and hence instrumentation of these canals was carried out using nickel titanium files, due to their flexibility, lesser risks of ledge formation and perforations.


   Conclusion Top


Failure to control infection in the root canal system has an adverse impact on outcome.

Clinicians therefore should be aware of anatomical variations in the teeth they are managing and should never assume that canal systems are simple. The majority of mandibular canines have one root and root canal, but 15% may have two canals, and a smaller number may have two distinct roots, both of which should be identified and managed.

 
   References Top

1.Sjogren U, Hagglund B, Sundqvist G, Wing K. Factors affecting the long-term results of endodontic treatment. J Endod 1990;16:498-504.  Back to cited text no. 1
    
2.Nair PN, Sjögren U, Krey G, Kahnberg KE, Sundqvist G. Intraradicular bacteria and fungi in root-filled, asymptomatic human teeth with therapy-resistant periapical lesions: A long-term light and electron microscopic follow-up study. J Endod 1990;16:580-8.  Back to cited text no. 2
    
3.Andrei OC, Mãrgãrit R, Dãguci L. Treatment of a mandibular canine abutment with two canals. Rom J Morphol Embryol 2010;51:565-8.  Back to cited text no. 3
    
4.Versiani MA, Pécora JD, Sousa-Neto MD. The anatomy of two-rooted mandibular canines determined using micro-computed tomography. Int Endod J 2011;44:682-7.  Back to cited text no. 4
    
5.Kvist T, Molander A, Dahlén G, Reit C. Microbiological evaluation of one- and two-visit endodontic treatment of teeth with apical periodontitis: A randomized, clinical trial. J Endod 2004;30:572-6.  Back to cited text no. 5
    
6.Pineda F, Kuttler Y. Mesiodistal and buccolingual roentgenographic investigation of 7,275 root canals. Oral Surg Oral Med Oral Pathol 1972;33:101-10.  Back to cited text no. 6
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7.Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol 1984;58:589-99.  Back to cited text no. 7
[PUBMED]    
8.Heling I, Gottlieb-Dadon I, Chandler NP. Mandibular canine with two roots and three root canals. Endod Dent Traumatol 1995;11:301-2.  Back to cited text no. 8
    
9.Orguneser A, Kartal N. Three canals and two foramina in a mandibular canine. J Endod 1998;24:444-5.  Back to cited text no. 9
    
10.Victorino FR, Bernardes RA, Baldi JV, Moraes IG, Bernardinelli N, Garcia RB, et al. Bilateral mandibular canines with two roots and two separate canals: Case report. Braz Dent J 2009;20:84-6.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]


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