Variations in the number of roots and canals have been extensively reported in endodontic literature. One rare variation is presence of two separate root canals in maxillary lateral incisors. This study reports a maxillary lateral incisor with two canals. Although rare, knowledge about this anatomical variation can help in successful endodontic treatment of such teeth.Keywords: Anatomic Variation; Root Canal; Tooth Abnormalitie

Bijari, Shima

Farahi, Forough

Saberi, Eshaghali

English

Journals Portal, Shahid Beheshti University of Medical Sciences

 IEJ Iranian Endodontic Journal 2018;13(3): 406-408 Endodontic Treatment of a Maxillary Lateral Incisor with Two Canals: A Case Report Eshaghali Saberi a, Shima Bijari a, Forough Farahi a* a Department of Endodontics, Oral and Dental Diseases Research Center, Dental School, Zahedan University of Medical Sciences, Zahedan, Iran  ARTICLE INFO  ABSTRACT Article Type: Case Report  Variations in the number of roots and canals have been extensively reported in endodontic literature. One rare variation is presence of two separate root canals in maxillary lateral incisors. This study reports a maxillary lateral incisor with two canals. Although rare, knowledge about this anatomical variation can help in successful endodontic treatment of such teeth.  Keywords: Anatomic Variation; Root Canal; Tooth Abnormalities Received: 27 Mar 2018 Revised: 20 May 2018 Accepted: 29 May 2018 doi: 10.22037/iej.v13i3.20986  *Corresponding author: Forough Farahi, Department of Endodontics, Oral and Dental Diseases Research Center, Dental School, Zahedan University of Medical Sciences, Zahedan, Iran. E-mail: f_farahi67@yahoo.com      Introduction ne important step in root canal treatment is to find, clean and disinfect all root canals. Knowledge about the variations of the root canal system of all teeth directly affects the outcome of endodontic treatment [1]. Presence of multiple canals in maxillary lateral incisors is a rare occurrence. According to Green [2], Pineda and Kuttler [3] and Vertucci [4], maxillary incisors are single-canal in 100% of the cases, and presence of multiple canals in these teeth is limited to case reports available in the literature [5-15]. Due to such a low prevalence rate, additional canals in maxillary incisors may be missed by dentists. On the other hand, the shape of crown is often normal in such teeth, and the additional canals are sometimes detected by routine radiographic examination [8].  This study reports endodontic treatment of a maxillary lateral incisor with two separate canals. Case Report A 35-year-old female was referred to Dental School of Zahedan University of Medial Sciences by her general dentist for consultation about endodontic treatment of her maxillary left lateral incisor (tooth #10). She complained of continuous vague pain in her anterior maxilla. Her medical history was unremarkable. Her maxillary left lateral incisor already had a prepared access cavity and did not respond to the vitality tests. It did not have pain on palpation or percussion. Her oral hygiene was moderate and she did not have any periodontal pocket around her maxillary left lateral incisor. The tooth did not have any sinus tract and the patient had no history of dental trauma. Radiographic examination revealed an unusual root canal system. The lake of centralization of the main canal. Non-surgical root canal treatment was planned for her. Local anesthesia was administered by supra-periosteal injection of 2% lidocaine plus 1:80000 epinephrine (Persocaine, DarouPakhsh, Tehran, Iran). Temporary dressing was removed and the access cavity outline was corrected to find possible anatomical variations. A rubber dam was placed for isolation of the tooth. One orifice was evident in the pulp chamber floor. The orifice of the second canal was found following negotiating the pulp chamber floor with a #10 K-file (Dentsply Maillefer, Ballaigues, Switzerland) and precurving the file palatally. Another radiograph was taken, which confirmed the presence of a second canal (Figure 1).  O IEJ Iranian Endodontic Journal 2018;13(3): 406-408 407 Saberi et al.   Figure 1. A) Preoperative periapical radiography of the maxillary left lateral incisor; B) radiography taken after detecting the root canals; C) Radiography taken for evaluation of master cone; D) Periapical radiography taken after completion of root canal filling; E) Follow-up radiography  The canals underwent mechanical and chemical debridement with M-two rotary files (25/0.06, 20/0.06, 15/0.05, 10/0.04) (VDW GmbH, Germany) for the palatal canal and up to 35/0.04, for the buccal canal using the standard technique. Irrigation was performed using 5.25% sodium hypochlorite.  After root canal instrumentation, 17% EDTA (Asia Chimi Teb, Tehran, Iran) was used to eliminate the smear layer. After rinsing with saline, the canals were dried with sterile paper points and filled with gutta-percha (Meta Biomed Co., Chungcheongbuk do, Korea) and AH-26 sealer (Dentsply, DeTrey, Konstanz, Germany) using lateral compaction technique. The tooth was then temporarily restored (Figure 1D). The patient was referred to prosthetic specialist for permanent restoration and a follow-up radiography was taken after six months (Figure1E).  Discussion Anatomical variations and dental anomalies such as fusion, gemination, dens in dent, palatogingival groove, distolingual groove and some changes in normal development of the Hertwig’s epithelial root sheath may be suggested for maxillary incisors with two canals or two roots [16-19]. According to a previous study, the prevalence of multiple canals is 3% in maxillary incisors [20].  Tooth gemination is a type of dental anomaly characterized by division of tooth during its development resulting in formation of two crowns with one root. In dental fusion, two separate tooth buds are fused during crown development resulting in formation of a tooth with double crowns and two canals in one root [18, 21].  In our case, preoperative clinical and radiographic examinations confirmed normal size of the crown. Thus, fusion (one large crown) and gemination (fused crowns) were ruled out.  Reports regarding lateral incisors with dens in dent or dens invagination and two roots are scarce [15, 22-27]. In our case, preoperative clinical examination did not reveal invagination of enamel or dentin that could cause dens in dent. Other developmental anomalies such as palatogingival groove or distolingual groove were also ruled out by clinical examination.  According to Bhashkar [18], normal root development occurs when the Hertwig’s epithelial root sheath is bended horizontally at the cementoenamel junction to narrow the cervical opening. In our reported case, the canals had a buccopalatal position. Except for two case reports [28, 29], most of the root canals of such teeth are positioned mesiodistally [17, 30-32].   Precise radiographic interpretation and taking radiographs from different angles as well as comprehensive knowledge about the morphology and variations of the root canal system aid the clinician in better detection of such cases. In most cases, use of magnifying loupes or a microscope can also be helpful. Moreover, novel radiographic modalities such as cone-beam computed tomography, which is a high-resolution three-dimensional technique can greatly help in detection of such anatomical variations [33]. Cone-beam computed tomography was not used for our patient since there was no doubt regarding the presence of a second canal, and other anomalies were all ruled out. Conclusion Our reported case highlights the significance of having comprehensive knowledge about the anatomy and morphology of root canals to reach a correct diagnosis. Radiographic examination from different angles and clinical examination are required for all teeth. Acknowledgment The author would like to thanks Dr. Shahreki for referring the patient. Conflict of Interest: ‘None declared’.  IEJ Iranian Endodontic Journal 2018;13(3): 406-408 408 Twin rooted maxillary lateral incisor References 1. Setzer FC, Boyer KR, Jeppson JR, Karabucak B, Kim S. Long-term prognosis of endodontically treated teeth: a retrospective analysis of preoperative factors in molars. J Endod. 2011;37(1):21-5. 2. Green D. A stereomicroscopic study of the root apices of 400 maxillary and mandibular anterior teeth. Oral Surg Oral Med Oral Pathol. 1956;9(11):1224-32. 3. Pineda F, Kuttler Y. Mesiodistal and buccolingual roentgenographic investigation of 7,275 root canals. Oral Surg Oral Med Oral Pathol. 1972;33(1):101-10. 4. Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol. 1984;58(5):589-99. 5. Tagger M. Tooth germination treated by endodontic therapy. J Endod. 1975;1(5):181-4. 6. Creaven J. Dens invaginatus-type malformation without pulpal involvement. J Endod. 1975;1(2):79-80. 7. Mehlman ES. Management of a totally fused central and lateral incisor with internal resorption perforating the lateral aspect of the root. J Endod. 1978;4(6):189-91. 8. Christie WH, Peikoff MD, Acheson DW. Endodontic treatment of two maxillary lateral incisors with anomalous root formation. J Endod. 1981;7(11):528-34. 9. Wolfe RE, Stieglitz HT. A fused permanent maxillary lateral incisor: endodontic treatment and restoration. N Y State Dent J. 1980;46(10):654-7. 10. Blaney TD, Hartwell GR, Bellizzi R. Endodontic management of a fused tooth: a case report. J Endod. 1982;8(5):227-30. 11. Friedman S, Mor H, Stabholz A. Endodontic therapy of a fused permanent maxillary lateral incisor. J Endod. 1984;10(9):449-51. 12. Sinai IH, Lustbader S. A dual-rooted maxillary central incisor. J Endod. 1984;10(3):105-6. 13. Mader CL, Konzelman JL. Double-rooted maxillary central incisor. Oral Surg Oral Med Oral Pathol. 1980;50(1):99. 14. Todd HW. Maxillary right central incisor with two root canals. journal of endodontics. 1976;2(8):227. 15. Zillich RM, Ash JL, Corcoran JF. Maxillary lateral incisor with two roots and dens formation: a case report. J Endod. 1983;9(4):143-4. 16. Lambruschini GM, Camps J. A two-rooted maxillary central incisor with a normal clinical crown. J Endod. 1993;19(2):95-6. 17. Cimilli H, Kartal N. Endodontic treatment of unusual central incisors. J Endod. 2002;28(6):480-1.          18. S B. Orban's oral histology and embryology: St Louis: Mosby; 1991. 19. Shubbar A, Bolhari B, Fakhari N, Alemi P, Nosrat A. Non-Surgical Retreatment of Maxillary Lateral Incisor with Unusual Anatomy: A Case Report and Mini Review. Iran Endod J. 2017;12(3):381-5. 20. Cheung GS. Survival of first-time nonsurgical root canal treatment performed in a dental teaching hospital. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2002;93(5):596-604. 21. Neville BW, Damm DD, Chi AC, Allen CM. Oral and maxillofacial pathology: Elsevier Health Sciences; 2015. 22. Collins IJ. Maxillary lateral incisor with two roots. Aust Endod J. 2001;27(1):37-8. 23. Platt JA. A two-rooted maxillary lateral incisor. Gen Dent. 1995;43(1):72. 24. Vire DE. Two-rooted maxillary lateral incisor. Oral Surg Oral Med Oral Pathol. 1985;59(3):321. 25. Fried IL, Winter AA. Diagnosis and treatment of a two-rooted maxillary lateral incisor. Periodontal Case Rep. 1984;6(2):40-4. 26. Afkar M, Gholamshahi M, Mohammadi M. Nonsurgical Treatment of Type II Dens Invaginatus in a Maxillary Lateral Incisor Using Cone-Beam Computed Tomography. Iran Endod J. 2018;13(1):132-4. 27. Bahmani M, Adl A, Javanmardi S, Naghizadeh S. Diagnosis and Treatment of a Type III Dens Invagination Using Cone-Beam Computed Tomography. Iran Endod J. 2016;11(4):341-6. 28. Rao Genovese F, Marsico EM. Maxillary central incisor with two roots: a case report. J Endod. 2003;29(3):220-1. 29. Lin WC, Yang SF, Pai SF. Nonsurgical endodontic treatment of a two-rooted maxillary central incisor. J Endod. 2006;32(5):478-81. 30. Thompson BH, Portell FR, Hartwell GR. Two root canals in a maxillary lateral incisor. J Endod. 1985;11(8):353-5. 31. Gonzalez-Plata RR, Gonzalez-Plata EW. Conventional and surgical treatment of a two-rooted maxillary central incisor. J Endod. 2003;29(6):422-4. 32. Sponchiado EC, Jr., Ismail HA, Braga MR, de Carvalho FK, Simoes CA. Maxillary central incisor with two root canals: a case report. J Endod. 2006;32(10):1002-4. 33. Rajput A, Talwar S, Chaudhary S, Khetarpal A. Successful management of pulpo-periodontal lesion in maxillary lateral incisor with palatogingival groove using CBCT scan. Indian J Dent Res. 2012;23(3):415-8. Please cite this paper as: Saberi E, Bijari S, Farahi F. Endodontic Treatment of a Maxillary Lateral Incisor with Two Canals: A Case Report. Iran Endod J. 2018;13(3):406-8. Doi: 10.22037/iej.v13i3.20986.   

Endodontic Treatment of a Maxillary Lateral Incisor with Two Canals: A Case Report

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Endodontic Treatment of a Maxillary Lateral Incisor with Two Canals: A Case Report

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