|Year : 2009 | Volume
| Issue : 3 | Page : 70-75
A case of unusual root morphology: Maxillary canine with two roots
Nagesh Bolla, Sarath Raj Kavuri
Department of Conservative Dentistry & Endodontics, SIBAR Institute of Dental Sciences, Guntur, A.P., India
|Date of Web Publication||23-Feb-2011|
Sarath Raj Kavuri
Department of Conservative Dentistry & Endodontics, SIBAR Institute of Dental Sciences, Guntur, A.P.
Source of Support: None, Conflict of Interest: None
| Abstract|| |
The case describes a 3 months follow-up of the treatment of a maxillary canine with two roots. Clinical examination revealed a maxillary canine with a large carious lesion and an exaggerated response to cold thermal tests. Radiographic examination revealed a large distal carious lesion that appeared to invade the pulp chamber. The radiograph also revealed what appeared to be an extra root in this permanent maxillary canine.
|How to cite this article:|
Bolla N, Kavuri SR. A case of unusual root morphology: Maxillary canine with two roots. J Int Clin Dent Res Organ 2009;1:70-5
|How to cite this URL:|
Bolla N, Kavuri SR. A case of unusual root morphology: Maxillary canine with two roots. J Int Clin Dent Res Organ [serial online] 2009 [cited 2021 Dec 9];1:70-5. Available from: https://www.jicdro.org/text.asp?2009/1/3/70/77042
| Introduction|| |
Morphologic variations of the root canal system of a tooth can adversely affect an operator's ability to perform endodontic procedures (Nair R et al. 1990)  . Failure to properly cleanse and shape all aspects of the root canal system may result in a treatment failure. Clinicians should be aware of possible anatomical variations in the teeth they are treating and should never assume that the canal systems are simple. Some clinicians have the perception that a given tooth will only present with a specific number of roots and/or root canal systems.
The pulp canal system in any tooth has the potential of being very complex with branching and divisions throughout the length of the root (Burns RC, Buchanan LS 1994)  . The varying number of root canal systems in different teeth, their anatomy and interconnections have been studied and reported in several studies (Pineda & Kuttler 1972, Bellizzi & Hartwell 1983, Vertucci 1984, Caliskan et al. 1995) ,,, . Alapati et al  and Onay and Ungor (2008)  reported the presence of Type II canal configurations in maxillary canines. The clinician must be familiar with the various morphologic patterns in order to have the greatest chance of performing successful endodontic treatment procedures.
The following case report describes the successful endodontic treatment of a very rare morphologic variation, a permanent maxillary canine with two roots & two canals.
| Case Report|| |
A 38 year-old healthy female patient reported to the Department Of Conservative Dentistry and Endodontics, SIBAR Institute of Dental Sciences, Guntur, Andhra Pradesh, India, with a chief complaint of pain for one week in the maxillary left anterior region. The pain was severe, sharp, localized and was initiated upon consuming hot substances. The pain lingered for several minutes, even after removal of stimulus and led to a disturbed sleep. Clinical examination revealed a large carious lesion associated with the maxillary left canine, 23 and this tooth gave an exaggerated response to the cold thermal test. The tooth was asymptomatic to palpation, responded with severe pain to percussion and no mobility was noted. Radiographic examination revealed a distal radiolucency consistent with active caries that appeared to invade the pulp chamber space. There appeared to be a slight widening of the periodontal ligament space at the apex of the tooth 23 [Figure 1]. A possible carious lesion was also noted on the adjacent tooth 24.
A diagnosis of symptomatic irreversible pulpitis with symptomatic apical periodontitis was established. Local anesthesia was administered and a medium thickness rubber dam of 6x6 inches (Hygienic; Coltene Whaledent) was placed to isolate tooth 23. Access to the pulp canal space was achieved using a round diamond bur (ISO 801001016, Komet, and Lemgo, Switzerland). Working length of 21mm was determined electronically using a Dentaport ZX Apex locator (J. Morita Mfg. Corp.). The canal was cleansed and shaped using ProTaper rotary NiTi files to size F1 (DENTSPLY Maillefer, Ballaigues, Switzerland). Even after thorough cleansing & shaping of the canal, bleeding was observed at the location of the root canal orifice. A confirmation radiograph was taken with a ProTaper file in place at the predetermined working length using a shift cone technique and a second root was noted [Figure 2]. The access cavity was extended in a palatal direction to facilitate the location of the extra canal [Figure 3]. A digital radiograph was taken with instruments in both root canals [Figure 4]. Working length for the palatal canal was established as being 24mm using the apex locator and verified radiographically. The palatal canal was then instrumented with ProTaper files to a final size of F1. A 5.25% solution of sodium hypochlorite (Niclor 5, Ogna, and Milan, Italy) and 17% EDTA with +0.2% cetrimide (Largal Ultra, Septodont, Saint Maitre, France) were used alternatively as irrigants at every change of instrument. The canals were obturated with gutta-percha and AH-26 sealer (De Trey; DENTSPLY, Switzerland) using a lateral condensation technique with size A and B spreaders (Maillefer) [Figure 5]. The patient was recalled after 3 months and found to be asymptomatic [Figure 6].
|Figure 2: Digital radiograph using shift cone technique showing Protaper file upto 21mm of working length & second root observed|
Click here to view
|Figure 3: Access opening of canine showing two separate canal orifices (B-buccal, P– palatal)|
Click here to view
|Figure 4: Radiograph showing working length of maxillary canine with two canals in two separate roots (B-buccal, P -palatal)|
Click here to view
|Figure 5: Post Operative Radiograph Obturated With Gutta-percha & Ah-26 Sealer|
Click here to view
| Discussion|| |
The objectives of root canal treatment are to debride the root canals of pulp tissue remnants, microorganisms and bacterial products prior to obturation, thus inducing a favorable environment for healing of periradicular tissues (Seltzers S and Bender I B 2000)  . Diagnosis and identification of the root canal system morphology is therefore imperative. The difficulties of diagnosis and the possible superimposition of canals on radiographic examination should be borne in mind when examining such cases. When locating extra canals, it is important to identify the periodontal ligament space that often projects onto the root surface and may resemble a canal. In this case report, examination of the pulpal floor and angled radiographs taken with a file in place confirmed the existence of the extra canal.
Many of the difficulties associated with root canal treatment are due to variations in root canal morphology. Knowledge of anatomic variations is essential because endodontic success is related to a thorough debridement of the root canal system. Vertucci (1984)  classified root canal systems into eight types, according to the number of canals present and their configuration.
Studies of maxillary canines revealed only one root canal to be present (Pineda & Kutler 1972, Vertucci 1984) , . Caliskan et al (1995)  reported that the main root canal system in maxillary canines could diverge into two separate root canal systems as the canal progressed apically. The root canals either converged along their course to end in a common apical opening or terminated as two distinct apical foramina. The highest reported incidence; however, is that of a single root canal system, accounting for 93.48% of all screened teeth in a Turkish population (Caliskan et al. 1995)  , 75.4% in Chinese Guanzhong population (Weng X et al. 2009)  and 94.2% in Sri Lankan Population ( Peiris R et al. 2008)  . The majority of maxillary canines have one root canal system, but according to Caliskan et al. 4.35% and Weng X et al.  2.3% may have two root canals but exit as single canal (Type III) and 2.17% may have two distinct root canals with separate apical foramina (Type V)  , both of which should be identified and managed (Hulsmann M and Schafer E 2009)  . To the best of our knowledge the occurrence of two roots and two separate canals as described in the present case, has not yet published.
| Conclusion|| |
This report presents the rare finding and successful treatment of a maxillary canine with two roots and two root canal systems. To the best of the authors' knowledge, such an anatomic variation has not been previously reported. This case report is presented to increase the awareness of clinicians that variations in root canal anatomy may be present in any anterior tooth group. Clinicians must be aware of potential anatomical variations in the teeth they are treating, and should never assume that the root canal systems are simple.
| Acknowledgment|| |
The authors would like to thank Professor Gary R. Hartwell, Chair, Department of Endodontics, UMDNJ for his keen guidance in the preparation of this manuscript.
Thanks to Dr L Krishna Prasad, Principal, SIBAR Institute of Dental Sciences, Guntur, India for his kind cooperation and support.
| References|| |
|1.||Nair R, Sjögren U, Krey G, Kahnberg KE, Sundqvist G (1990) Intraradicular bacteria and fungi in root filled, asymptomatic human teeth with therapy-resistant periapical lesion: a long-term light and electron microscopic follow-up study. Journal of Endodontics 16, 5808. |
|2.||RC, Buchanan LS (1994) Tooth Morphology and Access Openings. In: Cohen S, Burns RC, eds. Pathways of the Pulp, 6th edn.. Boston, MA, USA: Mosby, pp. 128-178. |
|3.||Pineda F, Kuttler Y (1972) Mesiodistal and buccolingual roentgenographic investigation of 7,275 root canals. Oral Surgery, Oral Medicine, Oral Pathology 33,10110. |
|4.||Bellizzi R, Hartwell GR (1983) Clinical investigation of in vivo endodontically treated mandibular anterior teeth. Journal of Endodontics 9, 246-8. |
|5.||Vertucci FJ (1984) Root canal anatomy of the human permanent teeth. Oral Surgery,Oral Medicine, Oral Pathology 58, 58999. |
|6.||Caliskan MK, Pehivan Y, Sepetcioglu F, Turkum M, Tuncers S (1995) Root canal morphology of human permanent teeth in a Turkish population. Journal of Endodontics 21, 2004. |
|7.||Alapati Subbarayudu, Zaatar Essam I., Shyama Maddi, Zuhair Nohoud Al (2006) Maxillary Canine with Two Root Canals. Med Princ Pract 15, 74-76 |
|8.||Onay OE, Ungor M (2008) Maxillary Canines with two root canals. Hacettepe Dis Hekimligi Fakultesi Dergisi 32(01), 20-24 |
|9.||Seltzers S and Bender I B (2000) The Interrelationship of pulp and periodontal disease. In: Seltzers S and Bender I B, eds. The Dental Pulp, 1st edn.. Chennai, India: All India Publishers & Distributors. Pp. 303-323. |
|10.||Weng X, Yu S, Zhao S, Wang H, Mu T, Tang R, Zhou X (2009) Root canal Morphology of permanent maxillary teeth in the Han Nationality in Chinese Guanzhong Area: A new modified root canal staining technique. Journal of Endodontics 35(5), 651-656. |
|11.||R, Pitakotuwage N, Kanazawa, Dissanayake U B (2008) Root canal morphology of permanent incisors and canines in a Sri Lankan population. Sri Lankan Dental Journal 38(01), 15-23. |
|12.||Hulsmann M, Schafer E (2009) Problems in gaining access to the root canal system. In: Hulsmann Michael, Schafer Edgar, ed. Problems in Endodontics: Et iolog y, Diagn osis and Treatment, 1s t ed n; pp. 145-172. Germany: Quintessence Publishing Co Ltd. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]