This report presents an endodontic therapy in an unusual case of a patient who had wide crowns of both permanent maxillary central incisors. The right maxillary ...
JOURNAL OF ENDODONTICS Copyright © 2002 by The American Association of Endodontists
Printed in U.S.A. VOL. 28, NO. 6, JUNE 2002
CASE REPORT Endodontic Treatment of Unusual Central Incisors Hale Cimilli, PhD, and Nevin Kartal, PhD
Clinical examination revealed vertical furrows on the buccal and palatinal surfaces of the incisors (Fig. 1). Radiographic examination showed that the right permanent maxillary central incisor had two separate canals with two fused roots and the left had one large root canal with a single root (Fig. 2). The patient had the normal number of teeth in the dental arch. The incisors were anesthetized and isolated with rubber dam. After endodontic access preparations, pulp tissues were removed and the canals were instrumented and shaped with K-files (Zipperer, Mu¨nchen, Germany). The coronal portions of the root canals were flared with a series of Gates Glidden burs (Maillefer, Ballaigues, Switzerland). Biomechanical preparations were completed with a step-back technique and irrigation with copious amounts of 5.25% sodium hypochlorite solution. The right permanent maxil-
This report presents an endodontic therapy in an unusual case of a patient who had wide crowns of both permanent maxillary central incisors. The right maxillary central incisor had two separate canals on a fused root and the left had a large root canal within one root.
Disturbances during morphodifferentiation of tooth germs are rare in the permanent dentition (1– 4). However, there are a few case reports describing endodontic treatment of such teeth in the literature (1, 5–9). This report describes endodontic therapy in an unusual case of a patient who had two unusual maxillary central incisors. CASE REPORT A 17-year-old male patient, having orthodontic therapy that involved the reduction of his central incisors’ diameter to the proper size to allow aligning of his maxillary dental arch, was referred for endodontic therapy.
FIG 1. Clinical appearance of the teeth.
FIG 2. Preoperative radiograph of tooth 8 and tooth 9. 480
Vol. 28, No. 6, June 2002
Treatment of Unusual Central Incisors
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DISCUSSION The case presented is rare in that this patient had different abnormalities in each permanent maxillary central incisor, i.e. the right had two separate canals with fused roots and the left had a large root canal with a single root. This case demonstrates the variability of developmental anatomical anomalies. The right maxillary central incisor was probably the result of fusion with a supernumerary tooth, because the tooth number in the dental arch was normal. When performing differential diagnosis, it is normally difficult to distinguish between fused (especially between a supernumerary tooth and a normal tooth) and geminated roots (10). Preoperative radiographic examination may aid in the diagnosis. Moreover, the examination of the access openings may help determine if the root canals are separate or not. Dr. Cimilli is assistant professor, and Dr. Kartal is professor, Department of Endodontics Faculty of Dentistry, Marmara University, Istanbul, Turkey. Address requests for reprints to Nevin Kartal, Zincirlikuyu Akademiler sitesi 4/82, 80600 Levent, Istanbul, Turkey.
References
FIG 3. Five-yr follow-up.
lary central incisor was obturated by using lateral condensation technique with the Thermafil obturators (Tulsa Dental Products, Tulsa, OK). The left permanent maxillary central incisor was obturated using lateral condensation with gutta-percha cones. At 5-yr follow-up, the teeth were asymptomatic with all clinical and radiographic findings (Fig. 3) within normal limits.
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