Year : 2005 | Volume
: 23 | Issue : 4 | Page : 204--206
An unusual presentation of all the mandibular anterior teeth with two root canals - A case report
AM Tiku1, RR Kalaskar1, SG Damle2,
1 Nair Hospital Dental College, Mumbai-08, India
2 Department of Pediatric Dentistry, Nair Hospital Dental College, Mumbai-08, India
A M Tiku
22 Milan apartments, Pali Road,Bandra West, Mumbai.400050
A rare case of two root canals in all mandibular anterior teeth is presented. The patient initially reported for the treatment of mandibular right central and lateral incisors. However, radiographic evaluation revealed variant root canal and apical foramen patterns.
|How to cite this article:|
Tiku A M, Kalaskar R R, Damle S G. An unusual presentation of all the mandibular anterior teeth with two root canals - A case report.J Indian Soc Pedod Prev Dent 2005;23:204-206
|How to cite this URL:|
Tiku A M, Kalaskar R R, Damle S G. An unusual presentation of all the mandibular anterior teeth with two root canals - A case report. J Indian Soc Pedod Prev Dent [serial online] 2005 [cited 2021 Jan 25 ];23:204-206
Available from: https://www.jisppd.com/text.asp?2005/23/4/204/19011
Successful endodontic therapy of a tooth demands that the dentist, should have a thorough knowledge of the root canal morphology, making it mandatory towards thorough radiographic evaluation and diagnosis of the status of the pulp canals as well as the periapical areas. Improper diagnostic protocol may lead to the failure of endodontic treatment.
A wide morphological divergence of the root canal systems is known to exist. Varying number of the root canals in different teeth, their anatomy and interconnections have been studied and reported by several authors.,, Vertucci has classified morphological patterns of the root canal systems into eight types., Generally, the mandibular incisors have one root canal with one apical foramen (Vertucci type I) or two root canals with one apical foramen(Vertucci type II). However, the occurrence of two root canals with two separate foramina (Vertucci typeIV) in the mandibular incisors is very rare viz 3% and 2% in the mandibular central incisors and lateral incisors respectively, and in canines it is 6%. Funato A has reported a case with two root canals and separate apical foramina in the mandibular central incisor.
This case report describes the successful endodontic retreatment of the mandibular right central and lateral incisors having vertucci type IV root canal morphological system. The case was followed up for period of thirty months. The striking feature of this report however was the presence of two root canals in all the mandibular anterior teeth which has not been reported earlier to the best of our knowledge.
A 12 years old boy reported to the department of Pediatric Dentistry, Nair Hospital Dental College, Mumbai, with mild pain in the permanent mandibular right anterior teeth of 15 days duration. On clinical examination, a zinc oxide eugenol temporary restoration was seen in mandibular right central and lateral incisors. Dental history revealed that the patient had undergone root canal treatment in these teeth one month back. Medical and family history was noncontributory. Preoperative radiograph revealed an overextended, poorly condensed root canal obturation in the mandibular right lateral incisor and periapical radiolucencies in mandibular right central and lateral incisors respectively [Figure 1]. A closer observation of the same radiograph revealed two root canals in 41; 42; 43, a rare morphological variation. As this was an unusual observation additional radiographs for the left mandibular incisors and canines were taken after treating symptomatic teeth which also revealed two root canals in them [Figure 2].
In view of the clinical symptoms, faulty obturation and periapical pathology, an endodontic retreatment of both the teeth was planned. The teeth were isolated with rubber dam and the temporary restorations of zinc oxide eugenol were removed. The access cavities were modified and the previously condensed gutta percha points were softened with chloroform and removed using K and H files alternatively. Careful exploration of the root canals revealed two separate canals, buccally and lingully in both the teeth with vertucci type IV morphology of root canals. Working length was established radiographically. The canals were prepared using a step back instrumentation technique upto 40 # instruments. A 2.5% of sodium hypochlorite and normal saline (sodium chloride injection I.P 0.9% w/v core health care limited) were alternatively used as irrigants at every change of instruments. The canals were dried with sterile paper points and were dressed with calcium hydroxide paste (pulpdent). The access cavities were then temporarily sealed with IRM. At 2 weeks follow up as the teeth were asymptomatic, obturation of the root canals was under taken with laterally condensed gutta-percha using lateral condensation technique. Post obturation radiograph was taken and the access cavities were sealed with IRM. The teeth were later taken up for jacket crowns [Figure 2]. The patient was followed up at regular interval of 1, 3, and 6 months respectively. At 6 months follow up, complete resolution of the periapical pathology was observed [Figure 3]. The patient was observed for thirty months during which the patient was completely asymptomatic [Figure 4].
Since the success of the endodontic treatment is related to a thorough debridment of the root canals and hermatic seal of the obturated materials, a good preoperative radiographic evaluation is necessary.
The anatomy of root canal systems dictates the condition under which root canal therapy is carried out and can directly affect its prognosis. Extra root or root canals if not detected are a major reason for failure of this treatment. Incomplete removal of all the irritants from the pulp space may increase the possibility of treatment failure., The main reasons for failure in endodontic treatment of mandibular incisors is the inability to detect the presence of a second root canal,which can then not be prepared and obturated during treatment.
The frequency of two root canals in the mandibular incisors is 45% as reported by Kartal and Yanikoglu, whereas the other reports give these percentages between 11.5% and 41.4% respectively. The percentage of two root canals (type vertucci IV) with separate apical foramina in the mandibular central and lateral incisors are 3% and 2% respectively and in the canines it is 6%.
In present case, two root canals with separate foramina were distinctly observed in the mandibular right central incisors which is very similar to a case presented by Funato etal, who reported a mandibular central incisor with two root canals and separate apical formina. Holtzman reported mandibular canine with three root canals and Arcangelo reported with two roots. However, in the present case report two root canals appeared in all the mandibular teeth. Additionally except for the mandibular right central and lateral incisors, which were vertucci type IV, the classification of root canals system of the other anterior teeth was not possible, as they were not indicated for root canal treatment.
Numerous antimicrobial agents have been recommended as inter appointment dressings. Calcium hydroxide paste is a simple and remarkably effective antimicrobial medicament. It has been shown to dissolve necrotic tissue and enhance the tissue dissolving effect of sodium hypochlorite solution. In the present case, calcium hydroxide (Pulpdent) was used as the intracanal medicament. At 15 days recall teeth were asymptomatic and thus taken up obturation. It is evident in the present case that faulty obturation of the root canals had led to the formation of periapical lesions. This could be attributed to the microleakage as the canals were not sealed properly. Careful radiographic examination of the root canal system are important prior to the root canal preparation, so as to detect and be aware of variations in root canal anatomy, before and during endodontic treatment procedures. Finally, it is also important that the endodontic treatment be reviewed periodically to ensure continuous healing without complications.
|1||Pineda F, KutlerY. Mesiodistal and buccolingual roentgenographic investigations of 7,275 root canals.Oral Surgery, Oral Medicine, Oral Pathology 1972;33:101-10. |
|2||Bellizzi R Hartwell G. Clinical investigation of in vivo endodontically treated mandibular anterior teeth. Journal of Endodontics 1983;9:246-8.|
|3||Caliskan MK, Pehivan Y, Sepetcioglu F, Tuncer SS. Root canal morphology of human permanent teeth in a Turkish population. Journal of Endodontics 1995;21:200-4.|
|4||Vertucci FJ. Root canal anatomy of mandibular anterior teeth . Journal of American Dental Association 1974;89:369-71.|
|5||Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surgery, Oral Medicine, Oral Pathology 1984;58:589-99.|
|6||Funato A, Funato H, Matsumoto K. Mandibular central incisor with two root canals. Endodontics and Dental Traumatology 1998;14:285-6.|
|7||Slowey RR. Radiographic aids in detection of extra root canals. Oral Surgery Oral Medicine Oral Pathology 1974;37:762-71.|
|8||Nair R, Sjogren U, Kreg G, Khanberg KE, Sandquist G. Intraradicular bacteria and fungi in root filled asymptomatic human teeth with therapy resistant periapical lesion- a long term light and electron microscope follow up study. Journal of Endodontics 1990;16: 580-8.|
|9||Sjogren U, Hagglund B, Sundquist G, Wing K. Factors affecting the long term results of endodontic treatment. Journal of Endodontics 1990;16:498-504.|
|10||Kartal N, Yanikoglu F C. Root canal morphology of mandibular incisors. Journal of Endodontics 1992;11:562-564.|
|11||Holtzman L. Root canal treatment of a mandibular canine with three root canals. Case report.International Endodontic Journal 1997;30:291-3. |
|12||7.D'Arcangelo C, Varvara G, De Fazio P. Root canal treatment in mandibular canines with two roots- A report of two cases. International endodontic Journal 2001;34:331-4.|
|13||Bystrom A, Claesson R, Sundquist G. The antibacterial effect of camphorated paramonochlorophenol, camphorated phenol,and calcium hydroxide in the treatment of infected root canals. Endodontics and Dental Traumatology 1985;1:170-5.|
|14||Hasselgren G, Olsson B, Cvek M. Effects of calcium hydroxide and sodium hypochlorite on the dissolution of necrotic porcine muscle tissue.Journal of Endodontics 1988;14:125-7.|