canine was unilateral, which is a unique condition in the dental literature. One of
the birooted .... Wheeler RC. Dental anatomy, physiology and occlusion. 5th ed ...
ISSN 0970 - 4388
Double-rooted primary canines: A report of three cases AYSE I. ORHANa, SAZIYE SARIb
Abstract This article reports three rare cases of birooted primary canines. In one of the three cases reported, the double-rooted primary canine was unilateral, which is a unique condition in the dental literature. One of the birooted primary canines was extracted for examination. Root canal morphology was examined using the clearing technique and three root canals were detected. The detection of birooted teeth requires a fastidious radiographic evaluation. Moreover, it should be kept in mind during endodontic therapy that the number of root canals might exceed the number of roots for these teeth. Keywords: Endodontic therapy, morphology, primary teeth, root anomaly, root canal
d a o l existence of n two root canals, one Introduction s in the mesial root and the w other in the distal root [Figuren4C]. The internal morphology obirooted canine iwaso evaluated using the clearing of the The single conical root is described in pedodontic and dental d technique, as follows:at morphology texts as the normal, most common form of e primary maxillary canine root. Birooted primary canines e icwas accessed with a file and the mesial l are an extremely rare dental anomaly, only a few cases offr The pulp chamber b were located. The tooth was immersed in and distal canals which have been reported since 1975. Although the r u 5% sodium hypochlorite solution for 6 h and in a 59% Hcl etiology of this anomaly is unknown, an ingrowth of tissue PFollowing).decalcification, fo asolution. the tooth was rinsed in from Hertwig’s epithelial root sheath has been suggested m e running water and dehydrated and black India ink was as a possible cause. This paper reports on three cases of w l o o injected via the pulp chamber. The tooth was placed in pure birooted primary canines. b m nalcohol for c 4 h and immersed in methyl salicylate for . a o l i fr dk clearing. w The cleared tooth was examined under a Case Reports a o stereomicroscope (Leica Microsystems AG, Wetzlar, e n Germany), revealing three different root canals – one each av Case 1 M k in the mesial, distal and palatinal directions [Figure 5A-C]. d y is e An 11-year 3-month-old Caucasian male was brought to our b m The mandibular left primary canine was found to be singleclinic for a routine dentalF examination. The child’s medical . d medical D rooted, whereas the maxillary and mandibular right primary history included no trauma, allergies oreprevious w P examination canines were missing and therefore the number of roots in t problems. An intra-oral revealed a mixed s w these teeth could not be evaluated. Periapical radiographs s dentition with multiple carious lesions, amalgam restorations i o of the patient’s 9-year old sister showed normal, mixed w and missing h teeth. Periapical radiographs revealed a doubleh ( rooted maxillary left primary canine [Figures 1-2]. A T ethe tooth revealed a normal dentition with no bifurcated primary canines. morphologic evaluation iof t shaped crown and an abraded s incisal surface resulting from Case 2 attrition [Figure 3].a A radiographic examination clearly A 4-year 9-month-old Caucasian male was seen for a routine showed the succedaneous permanent canine root to have [1,2]
[3-15]
[4]
dental examination. Intra-oral examination revealed fully erupted primary dentition and interproximal carious lesions on the maxillary primary molars. Panoramic and periapical radiographs revealed a double-rooted maxillary right primary canine [Figures 6-7]. Clinical examination showed the crown of this tooth to be normal in shape and size [Figure 8]. The patient’s other primary canines were single-rooted and he had no siblings.
developed to two-thirds of its full length; therefore, the decision was made to extract the primary canine. Following extraction, the roots were examined and found to be bifurcated labially [Figure 4A], but connected palatinally by a hard tissue bridge, giving them the appearance of a single, wide root [Figure 4B]. The mesial root was wider and longer than the distal root. Radiological evaluation of the extracted tooth revealed the
Case 3 a
Resident, bAssociate Professor, Department of Pediatric Dentistry, Faculty of Dentistry, Ankara University, 06500 Besevler-AnkaraTurkey J Indian Soc Pedod Prev Dent - December 2006
A 6-year-old Caucasian male came to our clinic with the chief complaint of a toothache in the lower left quadrant. He was 204
Double-rooted primary canines
in primary dentition. Intra-oral examination revealed a deep carious lesion on the primary mandibular left second molar, as well as an amalgam restoration and multiple carious lesions on several other primary teeth. Panoramic and periapical radiographs incidentally revealed bifurcation of both maxillary primary canines [Figures 9-10]. Clinical examination showed the shape and size of their crowns to be normal [Figure 11]. The mandibular canines were found to be single-rooted. The child’s medical history was unremarkable and he had no siblings.
present cases could not be attributed to a specific cause. A review of the dental literature revealed a tendency for this anomaly to occur more frequently in black and male children and bilaterally in the maxillary arch [Table 1]. All three of the present cases were white males and all three of the anomalies were located in the maxillary arch. In our case 3, birooted canines were bilateral in the maxillary arch, which is the form commonly reported in the dental literature. In case 1, the birooted primary canine was located in the left maxillary arch; however, the maxillary right primary canine was absent and thus could not be evaluated. The mandibular right primary canine was also absent and the mandibular left primary canine was single rooted. In case 2, all four primary canines were present, but only the maxillary right primary canine was birooted. This unilateral case is unique in the dental literature [Table 1].
In cases 2 and 3, the parents were informed about these root anomalies and the patients were kept under close observation in order to examine the time and pattern of primary canine root resorption and eruption of permanent canine teeth.
d a lo n Discussion s Morphologic evaluation of the extractedn canine in case 1 w oto that of the caseioreported by Paulson showed it to be similar As in all other birooted primary canines reported to date, d et al. The roots emanated from a long trunk, they were ttherootlingual root bifurcations in the three cases reported here were in a bifurcated labially and connected on surface by e the coronal third, indicating that biroot formation began c e i a hard tissue bridge and the mesial root was wider than the between 9 and 10 months postnatally. While doublel r f distal root. While radiological evaluation of the extracted rooted teeth are generally believed to be a result of enhanced b the existence of two root toothrin the first case indicated u expressivity of the gene initiating differential growth of . using the clearing o a third canalPwas detected canals, ) Hertwig’s epithelial root sheath, the above data bring to f that the number of root canals may mind the fact that trauma or other disturbances during etechnique, indicating m w l exceed the number of roots. This finding must be taken into morphodifferentiation may affect root form and size in later o o b m c consideration during clinical procedures, especially periods. In the present cases, however, there was a no n . o l k endodontic therapy. history of trauma, nor were any double-rooted primary i r d w canines detected in the sibling of the one patientawith a f oprimary canines cannot be detected by v Whileebirooted n sibling. As a result, the birooted primary canines in the a M dk s y i b me F d . e PD t ww s s i o (w h h T te i s a [9]
[3-15]
[13]
[13]
[16]
Table 1: Previously reported cases of birooted canines Authors/ year Brown, 1975[3] Kelly, 1978[4] Krolls and Donahue, 1980[5] Chow, 1980[6] Bimstein and Bystrom, 1982[7]
Canines Max Max Max Max Max
Location Bilateral Bilateral Bilateral Bilateral Bilateral
Age (Year) 4 5 5 5 5
Sex F F F M M
Race ? Black Black Black Black
Max-Mand
Bilateral
5
M
Caucasian
Paulson et al, 1985[9] Jones and Hazelrigg, 1987[10]
Max Max
Bilateral Bilateral
9.6 5
M M
Black Black
Saravia, 1991 Case 1[11] Case 2 Hayutin and Ralstrom, 1992 Case 1[12] Case 2 Ott and Ball, 1996 Case 1[13]
Max Max Max Max Max
Bilateral Bilateral Bilateral Bilateral Bilateral
4.6 4 4 1.8 8.6
M M M M M
Black Black Black Black Black
Case 2
Max
Bilateral
4.11
M
Black
Max-Mand Max Max-Mand
Bilateral ? Bilateral
8.4 4 6.4
M F M
Black Pueblo Japanese
Bryant and Bowers, 1982 [8]
Case 3 Winkler and Ahmad, 1997 [14] Mochizuki et al, 2001[15]
205
Siblings ?
?
?
?
Sister (13 year): normal permanent teeth Two older sisters: normal permanent teeth ? Brother (10 year): no dental anomalies ?
?
?
?
Older sister: normal
permanent teeth, one earlier radiograph with normal primary maxillary canine Older sister: normal primary canines No siblings No siblings ?
J Indian Soc Pedod Prev Dent - December 2006
Double-rooted primary canines
(A)
(B)
d a o l n s w n io do t a e c e i l r f b r o Pu ). f m e w l o b m no .c a il fro dk w a o e v n a M dk s y e i b F m . d D P te ww s s i o (w h h T te i s a
(C)
Figure 1: Panoramic view of case 1
Figure 4: (A) The labial view, (B) the palatinal view and (C) the periapical radiographic presentation of the extracted double-rooted maxillary left primary canine
Figure 2: Periapical radiograph of case 1 showing doublerooted maxillary left primary canine
Figure 5: Stereomicroscope photographs of the cleared tooth. (A) Three root canals were seen in mesial, (B) palatinal and distal (C) direction.
Figure 3: Intra-oral photograph of Case 1
Figure 6: Panoramic view of Case 2.
J Indian Soc Pedod Prev Dent - December 2006
206
Double-rooted primary canines
d a o nl s w n io do t a e c e i l r f b r u . o P ) f e w om l o b li a from kn w.c d o a e v n a M k y ed is b F .m intra-oral examination, they may easily be detected d routine D e P t wwby examination of routine dental radiographs. This unusual s s i o (w root anatomy can lead to endodontic and extraction h h complications, as well as problems in permanent tooth T eruption. It should be kept in mind during endodontic e t i therapy that the number of root canals may exceed the s number of roots. a
Figure 7: Periapical radiograph of case 2 showing doublerooted maxillary right primary canine
Figure 10: Periapical radiographs of case 3 showing doublerooted bilateral maxillary primary canines
Figure 8: Intra-oral photograph of case 2
Figure 11: Intra-oral photograph of Case 3
Acknowledgment The authors wish to thank Dr. Semih BERKSUN for his technical support.
References 1.
Figure 9: Panoramic view of case 3
2.
207
Wheeler RC. Dental anatomy, physiology and occlusion. 5th ed. Saunders: Philadelphia; 1974. p. 43-79. Sicher H, Dubrul EL. Oral anatomy. 6th ed. Mosby: St. Louis;
J Indian Soc Pedod Prev Dent - December 2006
Double-rooted primary canines 1975. p. 246-52. 3. Brown CK. Bilateral bifurcation of the maxillary deciduous cuspids. Oral Surg Oral Med Oral Pathol 1975;40:817. 4. Kelly JR. Birooted primary canines. Oral Surg Oral Med Oral Pathol 1978;46:872. 5. Krolls SO, Donahue AH. Double-rooted maxillary primary canines. Oral Surg Oral Med Oral Pathol 1980;49:379. 6. Chow MH. Bilateral double-rooted maxillary primary canines. An abbreviated case report. Oral Surg Oral Med Oral Pathol 1980;50:219. 7. Bimstein E, Bystrom EB. Birooted bilateral maxillary primary canines. ASDC J Dent Child 1982;49:217-8. 8. Bryant RH Jr, Bowers DF. Four birooted primary canines: Report of case. ASDC J Dent Child 1982;49:441-2. 9. Paulson RB, Gottlieb LJ, Sciulli PW, Schneider KN. Doublerooted maxillary primary canines. ASDC J Dent Child 1985;52:195-8. 10. Jones JE, Hazelrigg CO. Birooted primary canines. Oral Surg Oral Med Oral Pathol 1987;63:499-500. 11. Saravia ME. Bilateral birooted maxillary primary canines: Report of two cases. ASDC J Dent Child 1991;58:154-5.
12. Hayutin DJ, Ralstrom CS. Primary maxillary bilateral birooted canines: Report of two cases. ASDC J Dent Child 1992;59: 235-7. 13. Ott NW, Ball RN. Birooted primary canines: Report of three cases. Pediatr Dent 1996;18:328-30. 14. Winkler MP, Ahmad R. Multirooted anomalies in the primary dentition of Native Americans. J Am Dent Assoc 1997;128: 1009-11. 15. Mochizuki K, Ohtawa Y, Kubo S, Machida Y, Yakushiji M. Bifurcation, birooted primary canines: A case report. Int J Paediatr Dent 2001;11:380-5. 16. Sicher H. Orban’s oral histology and embryology. 5th ed. Mosby: St. Louis; 1962. p. 48-51.
d a o l n s w n io do t a e c e i l r f b r o Pu ). f m e w l o b m no .c a il fro dk w a o e v n a M dk s y e i b F m . d D P te ww s s i o (w h h T te i s a
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