The success of endodontic therapy requires knowledge of the internal and external dental anatomy and its variations in presentation. This case report involves endodontic treatment of a traumatized maxillary central incisor with two separate roots

Atbaee, Adnan

Jouyandeh, Mohammad Reza

Nabavizadeh, Mohammad Reza

Sedigh Shams, Mahdi

English

PubMed

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 135   CASE REPORT IEJ -Volume 5, Number 3, Summer 2010 Nonsurgical endodontic treatment of a maxillary central incisor with two separate roots: A case report   Mohammad Reza Nabavizadeh P1*P DDS, MS, Mohammad Reza Jouyandeh P2P DDS, Adnan Atbaee P1P DDS, MS, and Mahdi Sedigh Shams P1P DDS, MS 1. Assistant Professor of Endodontics, Dental School, Shiraz University of Medical Sciences, Shiraz, Iran. 2. Postgraduate Student of Endodontics, Dental School, Shiraz University of Medical Sciences, Shiraz, Iran.  Abstract   The success of endodontic therapy requires knowledge of the internal and external dental anatomy and its variations in presentation. This case report involves endodontic treatment of a traumatized maxillary central incisor with two separate roots. [Iranian Endodontic Journal 2010; 5(3):135-7]  Keywords: Incisor, Maxilla, Root canal.  Received March 2010; accepted June 2010 *Correspondence: Dr. Mohammad Reza Nabavizadeh, Department of Endodontic, Faculty of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran. E-mail: mohammadrezanabavizadeh@yahoo.com Introduction Elimination of infection from the root canal system and prevention of reinfection is one of the main objectives of non surgical endodontic treatment (1). Errors in debridement and shaping and obturation of root canal system can lead to endodontic failure and therefore adequate knowledge of anatomy of the root canal system and its variations are essential. These variations can also be found in maxillary central incisors (2-16). The purpose of this article is to report on the endodontic treatment of a maxillary central incisor with two distinct roots.   Case Report A 16 years old boy was referred for endodontic treatment of his discolored maxillary left central incisor. He reported a history of athletic trauma to that tooth 8 months previously.  Proceeding pulp vitality tests and radiographic examination, the tooth was diagnosed with asymptomatic apical periodontitis. The periapical radiograph revealed previous incomplete endodontic intervention. Moreover the tooth had a root configuration which suggested two separate roots with separate apices (Figure 1A). The periodontal ligament seemed to be widened at both apices. The tooth crown was clinically observed to be discolored when compared with the adjacent incisors.  2TAfter application of local anesthetic and rubber dam isolation, the tooth was accessed in the standard manner. Two distinct canal orifices were identified upon exploration of the pulp chamber (2TFigure2T 1B). Root canal working length was determined and then the root canal system was cleaned and shaped using Protaper Files (Dentsply, Maillefer, Ballaigues, Switzerland), Gates Glidden drills (Dentsply, Maillefer, Ballaigues, Switzerland), and sodium hypochlorite irrigant. Both canals were dried with paper points (Diadent, Tianjin, China) and obturated with gutta-percha (Orca, China) and AH-26 sealer (Denstply, Riodejaniro, RJ, Brazil), using warmed vertical condensation. The lingual access cavity 2T3Twas sealed with a polycarboxylate base (Hongchang Dental Equipment, China); subsequently, the tooth was restored with light cured composite resin (Shanghai A- Dental Products, China). The postoperative radiograph revealed two separate obturated canals with two separate roots ( 3TFigure 3T 1C).  3T he patient was given postoperative instructions and then dismissed. At the recall examination 3Tsix month post-operatively, he reported no symptoms or signs. Clinical examination also did not reveal any signs of pathology and the radiographs taken (Figure 1D) demonstrated no abnormalities and complete periapical osseous repair.  136  Nabavizadeh et al. IEJ -Volume 5, Number 3, Summer 2010   Figure 1. A) A pulpotomized right central incisor. Examination of the radiograph revealed the possibility of two roots. B) The working length measurement radiograph showed two files in two separated roots. C) Postoperative radiograph, two separated roots. D) Radiograph taken at six-month recall visit, showing healing of apical pathosis  Discussion 2T he prevalent opinion that maxillary central incisors possess only one root with one canal can lead to endodontic treatment failure. 2T he present report illustrates a rare case of maxillary central incisor with two root canals, without morphological anomaly of the crown. According to literature (5), there are no limits for the morphological variability of the root canal. So practitioners must 2T consider anatomical variation in number and architecture of root canal system. Vertucci (2) has reported that maxillary central incisor presents single root and single canal in 100% of the cases. There were few case reports describing an additional canal in the maxillary central incisor (3-12). However, a proportion of these cases were teeth that had undergone gemination or fusion (7,11). In these teeth canals were usually located mesiodistally to each other; however, in our study they were aligned buccolingually. Double crowns are characteristic in geminated teeth, and bifid crowns with one root is obvious in fused teeth (17). However, in this case anomalous crown anatomy was absent. Moreover, a diagnosis of dens invagination could be disregarded due to absence of enamel and dentin invagination in the pulp on the pretreatment radiograph. Palatogingival or distolingual groove was also absent clinically and radiographically.  It may be reasonable to assume that during epithelial diaphragm formation, an incident may induce the development of a horizontal flap of hertwigs epithelial root sheet and the fusion of this horizontal flap, results in the formation of second root without any alterations in the crown (18). However, this is a rare phenomenon and a maxillary central incisor with more than one root is an exceptional condition with only few case reports mentioned in literature (3-12).   Conclusion  The experience from the present case demonstrates the variability of root canal morphology of maxillary central incisor. The clinician should be careful; even the most routine of cases might deviate from the norm.  References  1. Cohen S. Hargreaves KM: Pathways of the pulp. 9 PthP Edition. Mosby Ins. 2006; pp. 290-2. 2. 12TSinai IH 12T, 12TLustbader S12T. A dual-rooted maxillary central incisor. 12TJ Endod12T 1984;10:105-6. 3. 12TVertucci FJ 12T. Root canal anatomy of the human permanent teeth. 12TOral Surg Oral Med Oral Pathol12T 1984;58:589-99. 4. 12TPatterson JM 12T. Bifurcated root of upper central incisor. 12TOral Surg Oral Med Oral Pathol 12T 1970;29:222. 5. 12THeling B 12T. A two-rooted maxillary central incisor. 12TOral Surg Oral Med Oral Pathol12T 1977;43:649. 6. 12TMader CL12T, 12TKonzelman JL12T. Double-rooted maxillary central incisor. 12TOral Surg Oral Med Oral Pathol12T 1980;50:99. 7. 12TLibfeld H 12T, 12TStabholz A12T, 12TFriedman S12T. Endodontic therapy of bilaterally geminated permanent maxillary central incisors. 12TJ Endod 12T 1986;12:214-6. 8. 12TMichanowicz AE 12T, 12TMichanowicz JP 12T, 12TArdila J 12T, 12TPosada A12T. Apical surgery on a two-rooted maxillary    137  Maxillary incisor with two roots IEJ -Volume 5, Number 3, Summer 2010 central incisor. 12TJ Endod12T 1990;16:454-5. 9. 12Tal-Nazhan S12T. Two root canals in a maxillary central incisor with enamel hypoplasia. 12TJ Endod 12T 1991;17:469-71. 10. 12TLambruschini GM 12T, 12TCamps J 12T. A two-rooted maxillary central incisor with a normal clinical crown. 12TJ Endod 12T 1993;19:95-6. 11. 12TCimilli H 12T, 12TKartal N 12T. Endodontic treatment of unusual central incisors. 12TJ Endod12T 2002;28:480-1. 12. 12TRao Genovese F12T, 12TMarsico EM 12T. Maxillary central incisor with two roots: a case report. 12TJ Endod12T 2003;29:220-1. 13. 12TGonzález-Plata-R R12T, 12TGonzález-Plata-E W 12T. Conventional and surgical treatment of a two-rooted maxillary central incisor. 12TJ Endod12T 2003;29:422-4. 14. Ghoddusi J, Zarei M, Vatanpour M. Endodontic treatment  of  maxillary  central  incisor     with two roots. A case report. N Y State Dent J 2007;73:46-7. 15. Sponchiado EC Jr, Ismail HA, Braga MR, de Carvalho FK, Simões CA. 12TMaxillary central incisor with two root canals: a case report. 12T J Endod 2006;32:1002-4. 16. Benenati FW. 12TEndodontic treatment of a maxillary central incisor with two separate roots: case report.12T Gen Dent 2006;54:265-6. 17. 12THosomi T 12T, 12TYoshikawa M 12T, 12TYaoi M 12T, 12TSakiyama Y 12T, 12T oda T 12T. A maxillary central incisor having two root canals geminated with a supernumerary tooth. 12TJ Endod 12T 1989;15:161-3. 18. Khojastepour L. Khayat A. Maxillary central incisor with two roots: A case report. Journal of dentistry, Tehran University of Medical Sciences 2005;2:74-7.  The Importance of a Well Written Paper  2TAn international report 20 years ago showed that most surveyed business executives cited writing as one of the most neglected skills in the business world, yet one of the most important to productivity. Ten years later, clear writing was noted as the most valued skill that 80 percent of employees did not have. Clear and concise writing skills in both Farsi and English are sometimes lacking in Iranian scientist, clinicians and researchers. At high school level, university entrance exams do not assess our essay writing abilities in any language, let alone scientific or creative writing skills. Moreover, there is a huge deficit of native English language teachers from Preschool to Universities and therefore a whole generation of educated skilled individuals may be unaware of the inadequacies of their second language.  2TScientific writing is more than just science; it is an art that needs patience, practice and training. Prose, like food, needs to be well presented, suitable for the audience and provided in small bites-for easy digestion. Whether writing a journal article in English or Farsi, the paper needs to be crystal clear; i.e.plain and simple.  Word by word or line by line translations from Farsi to English transform the text into an alien language. A whole paragraph that is thought or written in Farsi needs to be restructured before pen is put to paper. Repetitions may be appreciated in poetry and literature, yet they should be absolutely avoided in scientific writing. Long winded sentences should be broken down and grammar and writing style should be addressed. General recommendation would be to read up on scientific writing or take lessons; and finally practice, practice and practice.  We will be providing a series of short guidance notes on how to write and publish a good paper in English the forthcoming issues of IEJ.   Dr Laleh Marvasti  Dr. Sanam Kheirieh Technical and English Editor of IEJ  

Nonsurgical Endodontic Treatment of a Maxillary Central Incisor with Two Separate Roots: A Case Report

Mohammad Reza Nabavizadeh

Mohammad Reza Jouyandeh

Adnan Atbaee

Mahdi Sedigh Shams

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Nonsurgical Endodontic Treatment of a Maxillary Central Incisor with Two Separate Roots: A Case Report

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