[Downloaded free from http://www.jisppd.com on Friday, April 21, 2017, IP: 104.249.178.54] ISSN 0970 - 4388 An unusual presentation of all the mandibular anterior teeth with two root canals - A case report T IKU A. M. a , K ALASKAR R. R. b , D AMLE S. G. c Abstract 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. Key words: Anatomy, Endodontics, Mandibular, Retreatment, Two canals Successful endodontic therapy of a tooth demands that the days duration. On clinical examination, a zinc oxide eugenol dentist, should have a thorough knowledge of the root ca- temporary restoration was seen in mandibular right central nal morphology, making it mandatory towards thorough and lateral incisors. Dental history revealed that the patient radiographic evaluation and diagnosis of the status of the had undergone root canal treatment in these teeth one pulp canals as well as the periapical areas. Improper diag- month back. Medical and family history was noncontribu- nostic protocol may lead to the failure of endodontic treat- tory. Preoperative radiograph revealed an overextended, ment. poorly condensed root canal obturation in the mandibular right lateral incisor and periapical radiolucencies in man- A wide morphological divergence of the root canal systems dibular right central and lateral incisors respectively [Figure is known to exist. Varying number of the root canals in dif- 1]. A closer observation of the same radiograph revealed ferent teeth, their anatomy and interconnections have been two root canals in 41; 42; 43, a rare morphological varia- studied and reported by several authors. [1,2,3] Vertucci has tion. As this was an unusual observation additional radio- classified morphological patterns of the root canal systems graphs for the left mandibular incisors and canines were into eight types. [4,5] Generally, the mandibular incisors have taken after treating symptomatic teeth which also revealed one root canal with one apical foramen (Vertucci type I) or two root canals in them [Figure 2]. two root canals with one apical foramen(Vertucci type II). However, the occurrence of two root canals with two sepa- In view of the clinical symptoms, faulty obturation and peri- rate foramina (Vertucci typeIV) in the mandibular incisors is apical pathology, an endodontic retreatment of both the very rare viz 3% and 2% in the mandibular central incisors teeth was planned. The teeth were isolated with rubber dam and lateral incisors respectively, and in canines it is 6%. [5] and the temporary restorations of zinc oxide eugenol were Funato A has reported a case with two root canals and sepa- removed. The access cavities were modified and the previ- rate apical foramina in the mandibular central incisor. [6] ously condensed gutta percha points were softened with chloroform and removed using K and H files alternatively. This case report describes the successful endodontic Careful exploration of the root canals revealed two sepa- retreatment of the mandibular right central and lateral inci- rate canals, buccally and lingully in both the teeth with sors having vertucci type IV root canal morphological sys- vertucci type IV morphology of root canals. Working length tem. The case was followed up for period of thirty months. was established radiographically. The canals were prepared The striking feature of this report however was the pres- using a step back instrumentation technique upto 40 # in- ence of two root canals in all the mandibular anterior teeth struments. A 2.5% of sodium hypochlorite and normal sa- which has not been reported earlier to the best of our knowl- line (sodium chloride injection I.P 0.9% w/v core health care edge. limited) were alternatively used as irrigants at every change of instruments. The canals were dried with sterile paper Case Report 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 asymp- A 12 years old boy reported to the department of Pediatric tomatic, obturation of the root canals was under taken with Dentistry, Nair Hospital Dental College, Mumbai, with mild laterally condensed gutta-percha using lateral condensation pain in the permanent mandibular right anterior teeth of 15 technique. Post obturation radiograph was taken and the a Lecturer, b Lecturer, c Professor and Head of Department of Pediatric access cavities were sealed with IRM. The teeth were later Dentistry, Nair Hospital Dental College, Mumbai-08, India taken up for jacket crowns [Figure 2]. The patient was fol- J Indian Soc Pedod Prev Dent- December 2005 204
[Downloaded free from http://www.jisppd.com on Friday, April 21, 2017, IP: 104.249.178.54] Two root canals in mandibular anterior teeth detected are a major reason for failure of this treatment. [7] lowed up at regular interval of 1, 3, and 6 months respec- tively. At 6 months follow up, complete resolution of the Incomplete removal of all the irritants from the pulp space may increase the possibility of treatment failure. [8,9] The main periapical pathology was observed [Figure 3]. The patient was observed for thirty months during which the patient reasons for failure in endodontic treatment of mandibular was completely asymptomatic [Figure 4]. incisors is the inability to detect the presence of a second root canal,which can then not be prepared and obturated Discussion during treatment. [10] The frequency of two root canals in the mandibular incisors Since the success of the endodontic treatment is related to is 45% as reported by Kartal and Yanikoglu, [10] whereas the a thorough debridment of the root canals and hermatic seal other reports give these percentages between 11.5% and of the obturated materials, a good preoperative radiographic 41.4% respectively. [10] The percentage of two root canals (type evaluation is necessary. vertucci IV) with separate apical foramina in the mandibular central and lateral incisors are 3% and 2% respectively and in The anatomy of root canal systems dictates the condition the canines it is 6%. [5] under which root canal therapy is carried out and can di- rectly affect its prognosis. Extra root or root canals if not In present case, two root canals with separate foramina were distinctly observed in the mandibular right central incisors Figure 1: Preoperative radiograph revealing an overextended poorly condensed root canal obturation in the mandibular right lateral incisor Figure 3: Radiograph showing complete resolution of periapical pathology at 6 months follow up Figure 2: Radiograph of left mandibular incisors and canine showing two root canals Figure 4: Radiograph of the teeth at 30 months follow up 205 J Indian Soc Pedod Prev Dent- December 2005
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