Heal Talk // July-August 2015 // Vol 07 // Issue 05 37

Endodontics

Dr. Era Arora Senior Lecturer

Dr. Prashant BhasinReader

Dept. of Conservative Dentistry and Endodontics Santosh Dental College

(Ghaziabad)

Endodontic Retreatment of a Maxillary Central Incisor with Two Roots – A Case Report

Introduction

O

Case Report :

Discussion

Conclusion

In view of the clinical symptoms, According to the literature available in text ne of the main objectives of periapical pathology and faulty obturation, a books, 100% of these teeth show single canals, endodontic treatment is to prevent non-surgical endodontic retreatment was but studies over 30 years have reported that 3% or treat apical periodontitis by planned. of maxillary lateral incisors and 0.6%

removing bacterial colonies and necrotic The PFM crown was retained in view of the maxillary central incisors may have two pulpal remnants from the root canal system and esthetics of the patient and access was made canals. The description of multiple canals in sealing this space with a biocompatible through it. After administration of local these teeth is limited to case reports of material against any bacterial ingress. anaesthesia and application of rubber dam, anomalies known as fusion, gemination or However endodontic treatment can fail for access cavity was made through the porcelain dens invaginatus. There are few cases of many reasons, such as diagnostic errors, with a round diamond and through metal with a maxillary central incisors with two canals persistence of infection in the root canal trans-metal bur. Gutta-percha was removed reported in the literature and most of them system, errors in debridement and shaping of using Gates-Glidden drills and peaso reamers. present morphological alteration, such as the root canal systems, instrument fractures, Purulent discharge through the root canals was Macrodontia and fusion.poor restorations and extra roots or canals, if apparent, therefore inter-appointment calcium Diagnostic measures are important aids in not detected. Thus, a broad knowledge of both hydroxide dressing was given for 10 days. the location of additional root canal orifices. the external and internal anatomy of teeth is of Calcium hydroxide dressings were repeated These measures include obtaining multiple great importance for adequate endodontic for another two appointments. preoperative radiographs, examination of the treatment. Many anatomical studies have Working length was determined using size pulp chamber floor with a sharp explorer, declared that maxillary incisors are always 30 and size 40 K-files. Preparation was troughing grooves with ultrasonic tips, comprised of a single root, while variations in completed in mesial canal with size 55 K-file staining the chamber with dye, performing the number of lateral canals and/or position of and distal canal with size 70 K-file, alongwith champagne bubble test and visualisation of apical foramen are reported. As indicated in the 0.2% chlorhexidine and 2.5% sodium bleeding points. Careful examination of studies of canal anatomy, multiple canals and hypochlorite irrigation. Circumferential filing preoperative radiographs can aid in locating roots in maxillary incisors are rare and are with corresponding sized H-files was done and additional canals or roots. This might more often seen in lateral incisors than in smear layer was removed using 17% EDTA. necessitate taking radiographs from different central incisors. The incidence of an additional Treatment was completed in four angulations. In cases with complex root canal canal in the maxillary central incisor is appointments making sure there was no pus anatomy, cone beam or spiral computed

discharge from the canal. tomography can be used as an additional extremely rare and is reported to be ≈0.6%. A Following obturation with AH-Plus sealer and diagnostic tool. An endodontic microscope brief review in literature revealed that only a Gutta-percha using lateral condensation may be useful to locate the additional canal few cases of maxillary central incisors with technique access cavity was restored with orifices. The experience from the present case two roots and root canals have been reported. composite. demonstrates the variability of root canal The aim of the present study is to show a

Upon recall after 2 weeks post-obturation, morphology of maxillary central incisor. The clinical case of endodontic retreatment of a the tooth did not present with any tenderness or clinician should be careful that even the most maxillary central incisor with two roots.mobility. There was no pus discharge and the routine of cases might deviate from the usual. A 38 year old male patient with sinus tract was not apparent. Recall after six The success of endodontic treatment depends the chief complaint of pus discharge in relation months showed resolution of clinical on thorough debridement and a fluid tight seal to maxillary left central incisor reported to our symptoms and periapical lesion. of the obturation material. Additional root OPD. The patient gave a history of root canal

canals or other parts of an infected root canal treatment performed on the same tooth 2 years This was a rare case of maxillary central system that are not cleaned and obturated back. On examination intra-oral sinus and

incisor with two roots and root canals, without might provide a source of persistent irritation, grade I mobility were observed in relation to morphological anomaly of the crown. The two compromising the long term success of the root maxillary left central incisor which was roots possibly had a common orifice and canal therapy. Although both the canals were crowned. The tooth was tender on percussion. bifurcated in the middle third to form two located and filled in the previous root canal RVG revealed maxillary left central incisor separate roots with separate apical foramina. treatment, incomplete preparation in the apical with two roots, mesial and distal associated The two roots were unequal in length and third of the root canal did not resolve the with periapical radiolucency. There was no width. The distal root was longer and wider periradicular lesion. Thus, rendering the canal evidence of geminat ion or fus ion. than the mesial root. free of disease-causing micro-organisms Contralateral incisor was normal in

According to the literature, there are no should be ensured at every step of the morphology. limits for the morphological variability of the treatment. The cause of persistent periapical infection root canal. This emphasizes the need for was determined as inadequate obturation in the practitioners to take into consideration In conclusion, the clinician should be distal canal about 3-4 mm short of the anatomical variations in number and careful about the possible anatomical radiographic apex and over-obturation in architecture of the root canal systems. variations in the root canal configuration. mesial canal.

Heal Talk // July-August 2015 // Vol 07 // Issue 06 38

Endodontics

Careful preoperative evaluation with different Endod 2006, 32:478-81. report. Iran Endod J. 2012 Winter;7(1):36-diagnostic resources available should be 8. Sponchiado, E. C. Jr.; Ismail, H. A.; Braga, 9. Epub 2012 Mar 1.carried out to detect any possible variations in M. R.; de Carvalho, F. K. & Simões, C. A. 16. Benenati FW. Endodontic treatment of a root canal anatomy. The entire volume of the Maxillary central incisor with two root maxillary central incisor with two separate root canal space including accessory root canals: A case report. J. Endod. 2006, roots: case report. Gen Dent. 2006; canals and foramina should be thoroughly 32:1002-4. 54(4):265-6.cleaned and filled so that a fluid tight apical 9. Almeida-Gomes et al. Two root canals in 17. Sheikh-Nezami M MN. Endodontic seal is obtained. maxillary central incisor. RSBO. 2011 Jul- treatment of a maxillary central incisor

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5. Genovese FR, Marsico EM. Maxillary Thumu J. Re - treatment of a Two-rooted Fig 1: Pre-operative radiograph showing root central incisor with two roots: a case Maxillary Central Incisor - A Case Report. canal treated left central incisor with report. J Endod 2003 Mar;29(3):220-1. J Clin Diagn Res. 2014 Feb;8(2):253-5. associated peiapical lesion

6. Rodrigues, E. A. & Silva, S. J. A. A case of 14. Maghsoudlou A, Jafarzadeh H, Forghani Fig 2: Gutta-percha removedunusual anatomy: maxillary central incisor M. Endodontic treatment of a maxillary Fig 3: Working lengthwith two root canals. Int. J. Morphol 2009, central incisor with two roots. J Contemp Fig 4: Master cone27(3):827-830. Dent Pract. 2013 Mar 1;14(2):345-7. Fig 5: Obturation

7. Lin, W. C.; Yang, S. F. & Pai, S. F. 15. Krishnamurti A, Velmurugan N, Nandini S. Nonsurgical endodontic treatment of a Management of single-rooted maxillary two-rooted maxillary central incisor. J. central incisor with two canals: a case

References

Legands

Arora, et at.: Endodontic Retreatment of a Maxillary Central Incisor with Two Roots – A Case Report

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