|Year : 2012 | Volume
| Issue : 2 | Page : 79-82
Unusual anatomy of maxillary central incisor with two roots
TS Ashwini Shivakumar, Saleem Makandar, Ajay Kadam
Department of Conservative Dentistry and Endodontics, Maratha Mandal's Nathajirao G. Halgekar, Institute of Dental Sciences and Research Centre, Belgaum, Karnataka, India
|Date of Web Publication||3-Sep-2012|
T S Ashwini Shivakumar
Bauxite Road, Belgaum, Karnataka
Source of Support: Gratitude the Principal and Head of Department of Conservative Dentistry and Endodontics, Maratha Mandal Nathajirao G. Halgekar Institute of Dental Sciences, Belgaum, Conflict of Interest: None
Introduction: Knowledge of root canal morphology is essential for successful endodontic therapy. Failure to recognize unusual root canal anatomy may lead to unsuccessful endodontic treatment. Case Report: This case report describes the successful endodontic treatment of the maxillary central incisor with unusual anatomy of two roots and two root canals. A 23-year-old male patient was referred for dental consultation with discoloration of the maxillary right central incisor with periapical lesion, which revealed unusual anatomy of root on radiographic examination, and was confirmed upon exploration. Discussion: As described by Vertucci, the maxillary central incisor presents a single root and single root canal in 100% of the cases. However, few cases of maxillary central incisors with two canals were reported in the literature, most of which were associated with developmental anomalies like fusion, germination or dens invaginatus. Clinician should be aware of the unusual anatomical variations that should be detected by the different diagnostic resources available.
Keywords: Maxillary central incisor, spiral CT scan, two roots
|How to cite this article:|
Ashwini Shivakumar T S, Makandar S, Kadam A. Unusual anatomy of maxillary central incisor with two roots. Dent Hypotheses 2012;3:79-82
| Introduction|| |
Knowledge of root canal morphology is essential for successful endodontic therapy.  Failure to recognize unusual root canal anatomy may lead to unsuccessful endodontic treatment.  Hence, it is important that dentists consider the anatomical variations of root canal systems.  Majority of the anatomical studies have found that maxillary central incisors are single-rooted teeth with a single canal.  The presence of an additional root or root canal in the maxillary central incisor is rare; however, few cases have been reported in the literature. ,,,,,,,,,,,, This case report describes a maxillary central incisor with unusual anatomy of two separate roots, which was treated by conventional endodontic treatment.
| Case Report|| |
A 24-year-old male patient reported to the dental hospital complaining of discoloration of the maxillary central incisor. His medical history was non-contributory. Past dental history revealed extraction of the right lateral incisor 9 years back due to ectopic eruption on the disto-palatal region. Clinically, enamel hypoplasia and mild discoloration of the right central incisor was observed [Figure 1]. Vitality tests show no response with heat, cold or electric pulp tests (EPT). Radiographic examination revealed periapical radiolucency with presence of two roots superimposing over each other. The tooth was diagnosed as having necrotic pulp with chronic apical periodontitis. The mixed radiopaque and radiolucent lesion measured approximately 5 mm Χ 7 mm and was roughly triangular with ill-defined borders [Figure 2].
After rubber dam application, endodontic access was gained. Two canal orifices, facial and disto-palatal, were located with a DG-16 endodontic explorer using endodontic loupes. It was difficult to negotiate the disto-palatal canal initially due to presence of initial curvature at the cervical third of the canal. The access cavity was extended on the disto-palatal aspect to enhance accessibility and instrumentation. Working length was determined using an apex locator (Propex II, Dentsply mallifier, Ballaigues, Switzerland) and confirmed with Radio Visio G raphy after coronal flaring with Gates Glidden Drills #1, #2 and #3. Cleaning and shaping of the root canals was performed using hand instruments and with a passive step-back technique. The facial canal was instrumented to a master apical file size of 60 and disto-palatal canal to size of 40 ISO size K-file. Intermittent irrigation was done with 3% sodium hypochlorite solution and saline. Calcium hydroxide with iodoform (metapex, Metabiomed, Horsham, USA Co.) was used as an intracanal medicament. After 2 weeks, the root canals were irrigated and obturated with gutta-percha and AH-Plus sealer using the cold lateral compaction technique [Figure 3]. A spiral computed tomography was performed with panoramic and axial sections to verify the limits of the root canal filling and bifurcation between the two canals at various levels [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8] and [Figure 9].
| Discussion|| |
The present report demonstrates a rare case of central incisor with two roots and two root canals that was successfully treated by non-surgical endodontic treatment. As described by Vertucci, maxillary central incisor presents a single root and single root canal in 100% of the cases.  However, few cases of maxillary central incisors with two canals were reported in the literature, most of which were associated with developmental anomalies like fusion, germination or dens invaginatus. 
Various case reports have been mentioned that have successfully been treated by non-surgical and surgical means. ,,,, In the present clinical report, the two roots were distinguishable, visible on the pre-operative radiograph. Careful interpretation of the radiograph is important in clinical endodontics.  The pre-operative radiograph of dual-rooted maxillary central incisor showed double radiolucent lines around the root surface. This can be misinterpreted as fusion of central incisor with another tooth or presence of retained root stump. Presence of two roots was then confirmed with angled radiographs and instruments.
According to a study by Brynolf with three to four parallax radiographs, correct endodontic diagnosis was obtained 90% of the time compared with one radiograph (74%). , Therefore, the clinician should take more than one radiograph from different angulations. Tracing the outline of the root surface cautiously can also help in the diagnosis.
Considering the acute curvature of the disto-palatal root and also large buccal canal, step-back hand instrumentation was preferred. Unusual morphology, when encountered, may complicate conventional treatment, as seen in one case report of treating two rooted maxillary central incisors, in which a great caution was necessary.
| Acknowledgment|| |
The authors acknowledge with profound gratitude the Principal and Head of Department of Conservative Dentistry and Endodontics, Maratha Mandal Nathajirao G. Halgekar Institute of Dental Sciences, Belgaum, for the support and encouragement.
| References|| |
|1.||Lin WC, Yang SF, Pai SF. Nonsurgical endodontic treatment of a two-rooted maxillary central incisor. J Endod 2006;32:478-81. |
|2.||González-Plata-RR, González-Plata-EW. Conventional and surgical treatment of a two-rooted maxillary central incisor. J Endod 2003;29:422-4. |
|3.||Sponchiado EC, Ismail HA, Braga MR, de Carvalho FK, Simões CA. Maxillary central incisor with two root canals: A case report. J Endod 2006;32:1002-4. |
|4.||Genovese FR, Marsico EM. Maxillary central incisor with two roots: A case report. J Endod 2003;29:220-1. |
|5.||Khojastehpour L, Khayat A. Maxillary central incisor with two roots: A case report. J Dent (Tehran) 2005;2:74-7. |
|6.||Rodrigues EA, Silva SJ. A case of unusual anatomy: Maxillary central incisor with two root canals. Int J Morphol 2009;27:827-30. |
|7.||Cabo Vale M, Gonzales JM. Maxillary central incisor with two root canals: An unusual presentation. J Oral Rehabil 2001;28:797-8. |
|8.||Patterson JM. Bifurcated root of upper central incisor. Oral Surg Oral Med Oral Pathol 1970;29:222-4. |
|9.||Heling B. A two-rooted maxillary central incisor. Oral Surg Oral Med Oral Pathol 1977;43:649-52. |
|10.||Mader CL, Konzelman JL. Double-rooted maxillary central incisor. Oral Surg Oral Med Oral Pathol 1980;50:99-101. |
|11.||Sinai IH, Lustbader S. A dual-rooted maxillary central incisor. J Endod 1984;10:105-6. |
|12.||Michanowicz AE, Michanowicz JP, Ardila J, Posada A. Apical surgery on a two-rooted maxillary central incisor. J Endod 1990;16:454-5. |
|13.||Cimilli H, Kartal N. Endodontic treatment of unusual central incisors. J Endod 2002;28:480-1. |
|14.||Vertucci F. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol 1984;58:589-99. |
|15.||Lambruschini GM, Camps J. A two-rooted maxillary central incisor with a normal clinical crown. J Endod 1993;19:95-6. |
|16.||Sherwood AI. Pre-operative diagnostic radiograph interpretation by general dental practitioners for root canal treatment. Dentomaxillofac Radiol 2012;41:43-54. |
|17.||Patel S, Dawood A, Whaites E, Pitt Ford T. New dimensions in endodontic imaging: Part 1. Conventional and alternative radiographic systems. Int Endod J 2009;42:447-62. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]