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Year : 2007  |  Volume : 10  |  Issue : 2  |  Page : 74-76
Maxillary incisor with two roots - a case report

1 Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai, India
2 Department of Conservative Dentistry and Endodontics, Ragas Dental College and Hospital, Uthandi, Chennai, India

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Keywords: tooth abnormalities, root canal therapy.

How to cite this article:
Emmanuel, Indira R, Kandaswamy D. Maxillary incisor with two roots - a case report. J Conserv Dent 2007;10:74-6

How to cite this URL:
Emmanuel, Indira R, Kandaswamy D. Maxillary incisor with two roots - a case report. J Conserv Dent [serial online] 2007 [cited 2023 Dec 6];10:74-6. Available from:

   Introduction Top

Endodontic therapy of abnormal root canal morphology is a challenge to the most experienced professional, and in a great number of situations, the tooth must be extracted. The vast majority of cases in the literature report development changes representing anomalies such as radicular grooves, fusion, gemination, dens invaginatus, c-shaped canals and concrescence. More than one canal in maxillary central incisor is not a very common finding.

The following describes the endodontic management of a maxillary right central incisor that could be diagnosed as gemination, as well as the treatment of periapical and lateral bone loss with the aid of calcium hydroxide.

   Case report Top

A 16 -year-old male in good health was referred for endodontic treatment of maxillary right central incisor. Clinical examination revealed a periapical swelling in relation to the tooth. Probing revealed no periodontal pocketing around the tooth. Radiographic evaluation showed that tooth had two separate canals. Periapical and lateral radiolucencies were associated with the tooth. The corresponding tooth on the opposite side of the arch seemed radio graphically and clinically normal. The adjacent lateral incisor showed haziness near the root apex.

Without anesthesia and using carbide burs access opening was done. The working length radiograph revealed two canals at the apex with fully developed roots. The root canals were thoroughly instrumented with Gates-Glidden drills and K-type files using 2.5% sodium hypochlorite irrigation. After drying with paper points, the canals were filled with a thick mixture of calcium hydroxide and glycerin. The calcium hydroxide paste was changed every 3 weeks for 6 months.

Master gutta percha points were then cemented in place with a calcium hydroxide based cement (Seal apex sealer). Lateral condensation with accessory gutta-percha points of the canal was done. The lingual access opening was sealed with resin reinforced glass ionomer cement.

At the 4-year recall appointment, after completion of orthodontic treatment, the tooth was symptom-free, all clinical findings were within normal limits and bone healing appeared to be improved.

   Discussions Top

In the present case, the root canals were filled only after radiographic signs of bone healing, related to the apical and mesial aspect of the root. Because of its high pH (12.5), calcium hydroxide is an effective antibacterial agent, and has been reported to favorably influence the local environment at the resorption site, leading to healing. It has also been shown to change the environment in the dentin and hone to a more alkaline pH, which has been postulated to slow down the action of the resorptive cells and promote hard tissue formation and repair.

During endodontic therapy, the dentist must be prepared for unusual root canal anatomy, taking into account the importance of careful radiographic evaluation that may lead to identification of such abnormalities increasing the rate of success.

Some degree of confusion can occur over the classification of gemination and fusion. In fact, attempts to distinguish differences between the two anomalies have no clinical relevance. Although two individual canals may lead to diagnosis of fusion, the diagnosis of gemination can also be made, because there were no missing teeth. In addition, it is interesting to observe that in contrast to these anomalies, the crown of the tooth was almost normal in size, favoring the diagnosis of dens invaginatus. Nevertheless, cervical lingual groove (clinically) and invagination of enamel to the interior of the root (radio graphically) were not observed here. This tooth was diagnosed as gemination which might have had change in formation of Hertwig root sheath due to traumatic injury.[13]

   References Top

1.Hosomi T, Yoshikawa M, Yaoi M, Sakiyama Y, Toda T. A maxillary central incisor having two root canals geminated with a supernumerary tooth. JEndod.I989Apr; 15(4): 161-3.  Back to cited text no. 1    
2.Michanowicz AE, Michanowicz JP, Ardila J, Posada A. Apical surgery on a two-rooted maxillary central incisor. J Endod. 1990 Sep; 16(9):454-5.  Back to cited text no. 2    
3.Al-Nazhan S. Two root canals in a maxillary central incisor with enamel hypoplasia. J Endod. 1991 Sep; 17(9):469-71.  Back to cited text no. 3    
4.Van der Vyver PJ, Traub AJ. Maxillary central incisor with two root canals: a case report. J DentAssoc SAfr. 1995 Mar;50(3):132-3.  Back to cited text no. 4    
5.Saito Kaoru, Chujo Masayuki, Root end formation with two root canals in incomplete upper central incisor with a periapical lesion.Journal of Japan Endodontic Society Vol. 21;NO.I;PAGE.43-47(2000)  Back to cited text no. 5    
6.Cabo-Valle M, Gonzalez-Gonzalez JM. Maxillary central incisor with two root canals: an unusual presentation.J Oral Rchabil. 2001 Aug; 28(8):797-8.  Back to cited text no. 6    
7.Genovese FR, Marsico EM. Maxillary central incisor with two roots: a case report. J Endod. 2003 Mar;29(3):220-1  Back to cited text no. 7    
8.Braun A, Appel T, Frentzen M. Endodontic and surgical treatment of a geminated maxillary incisor. Int Endod J. 2003 May;36(5):380-6.  Back to cited text no. 8    
9.M. Cabo-Valle, J. M. Gonzalez-Gonzalez Maxillary central incisor with two root canals: an unusual presentation Endodontic Topics Vol. 10 Issue 1 Page 3 March 2005  Back to cited text no. 9    
10.Lin WC, Yang SF, Pai SF. Nonsurgical endodontic treatment of a two-rooted maxillary central incisor.J Endod. 2006 May;32(5):478­81. Epub 2006 Feb 17.  Back to cited text no. 10    
11.Benenati FW. Endodontic treatment of a maxillary central incisor with two separate roots: case report.Gen Dent. 2006 Jul­Aug;54(4):265-6.  Back to cited text no. 11    
12.Sponchiado EC Jr, Ismail HA, Braga MR, de Carvalho FK, Sim6es CA. Maxillary central incisor with two root canals: a case report. J Endod. 2006 Oct;32(10):1002-4. Epub 2006 Jul 3  Back to cited text no. 12    
13.Ghoddusi J, Zarei M, Vatanpour M. Endodontic treatment of maxillary central incisor with two roots. A case report. N Y State Dent J. 2007 Jun­Jul;73(4):46-7.  Back to cited text no. 13    

Correspondence Address:
Department of Conservative Dentistry and Endodontics, Meenakshi Ammal Dental College and Hospital, Maduravoyal, Chennai
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0972-0707.42297

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This article has been cited by
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[Pubmed] | [DOI]


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