0099-2399/85/1105--0224/$02.00/0 JOURNAL OF ENDODONTICS Copyright 9 1985 by The Arnedcan Association of Endodontists

Printed in U.S.A. VOL. 11, NO. 5, MAY1985

CASE REPORT

Maxillary Canine with Two Roots

Canino Superior con Dos Raices

Rahmat A. Barkhordar, DMD, and Nguyen T. Nguyen, DOS

This report illustrates the relatively uncommon anomaly of a maxillary canine with two roots. Failure to recognize this anomaly probably contributed to a previous furcation perforation. Subsequent surgical treatment resulted in retention of the tooth as a successful abutment at 3 yr postoperative.

Esta presentacion ilustra la anomalia relativamente poco frecuente de un canino superior con dos ra- ices. El fracaso en el reconocimiento de esta an- omalia probablemente contribuyb a una perforacion previa en la furacion. El tratamiento quir0rgico pos- terior dio como resultado la conservacibn del diente como pilar ,',til a tres aSos de control postoperatorio.

One of the main reasons for failure of root canal therapy is lack of knowledge of pulp cavity anatomy and failure to negotiate and obturate the canal in its entirety (1). To avoid these failures, the dentist must consider the anatomy of the tooth before beginning the treatment. Radiographs should be taken from several different angles to study and diagnose morphological aberra- tions. There have been many reports concerning de- scriptions of teeth having morphological abnormalities such as gemination, fusion, and deviations in shape and number of root canals (2-8).

The incidence of two or three root canals in mandi- bular anterior teeth has been documented (9-14). The incidence is reported to be as low as 1% and as P'igh as 43%. Barrett (9) reported 31.2% of mandibular can- ines with two canals, while Green (12) claimed a fre- quency of 19.3%. However, aberrations of maxillary anterior teeth are less frequently reported in the litera- ture. Tagger (5) reported a geminated maxillary lateral incisor, Mehlman (6) treated a fused maxillary central and lateral incisor, and Christie et ai. (15) reported two cases of gemination of maxillary lateral incisors. Re- cently, Blaney etal. (16) reported a case of a maxillary

224

FiG 1. Maxillary canine identification. A, Labial view showing position of maxillary left canine. B, Incisal view of maxillary left canine filled with tooth-colored material (arrow).

lateral incisor fused with a supernumerary lateral incisor and Zillich et al. (17) reported a case of a maxillary lateral incisor with two canals.

The purpose of the present case report is to increase our awareness of morphological aberrations of the maxillary canine and to emphasize the importance of radiographs taken from different angles before and during treatment.

The following describes a case of a maxillary canine with two distinct roots.

CASE REPORT

A 58-yr-old female in exemplary health sought treat- ment for the chief complaint of increased soreness in

Vol. 11, No. 5, May 1985 Canine with Two Roots 225

FtG 2. A, Radiograph of the maxillary left anterior region showing canine with two distinct roots and gutta-percha extending through the furcation. B, Radiograph of the maxillary right anterior region showing right canine with one root.

FIG 3. A full-thickness trapezoid flap extending from mesial of lateral incisor to edentulous area distally.

the maxillary left canine region of 1-month duration. The patient indicated that the tooth had been treated endodontically 10 months earlier. She had experienced a slight tenderness around the apical area of the tooth since that treatment. A recent increase in soreness motivated her to seek advice and further treatment.

Upon clinical examination, the maxillary left canine revealed large composite fillings on the labial, distal, and lingual surfaces. The left central and lateral incisors were covered with full veneer crowns (Fig. 1). Roent- genograms revealed the maxillary left canine with two roots (Fig. 2A) and the maxillary right canine with one

FtG 4. Surgical site. Bone window created on mesial side of canine for removal of protruding filling material.

root (Fig. 2B). The left canine exhibited advanced cal- cification of both root canals, with no apparent periap- ical bone destruction, and showed root filling material extending 10 mm into the bone through a perforation of the furcation (Fig. 2A). Our treatment called for conservative retreatment of the canine and surgical removal of the extended filling material, followed by the construction of a fixed bridge.

After an unsuccessful attempt to negotiate the cal- cified root canals, the involved area was surgically

226 Barkhordar and Nguyen

exposed by reflecting a full-thickness buccal flap with vertical incisions on the mesial of the lateral incisor and in the edentulous area (Fig. 3). Cortical bone was removed from the mesial aspect of the canine, the filling

Joumal of Endodontics

material was removed, and excess gutta-percha was burnished with a warm burnisher to seal the perforation in the furcation area (Fig. 4). Since no periapical Pa- thology was present, no attempt was made to retrofill

FIG 5. A, Immediate postsurgical radiograph. B, One-year postoperative radiograph. There is no evidence of pathological change at root apices of the calcified tooth and thereis progressive healing in the furcation. C, Thme-year postoperative radiograph with no further bone loss in the furcation and no periapical changes. Tooth is functioning as abutment for a fixed bridge.

Vol. 11, No. 5, May 1985

the roots. The operative site was closed with 4-0 silk suture and a radiograph was taken (Fig. 5A). On the 7th postoperative day, the sutures were removed. The healing process was uneventful.

Radiographs taken 1 and 3 yr postoperatively re- vealed satisfactory healing with no apparent radi- ographic changes at the apices of the maxillary canine (Fig. 5, B and C). The tooth was firm and clinically asymptomatic. Periodontal probings were within normal limits, and there was no evidence of further bone loss in the furcation.

DISCUSSION

From our initial radiographic examination, it was ob- vious that this maxillary canine had an unusual config- uration. The two roots are clearly visible on the radi- ographs. If good diagnostic radiographs had been taken at different angles before the original endodontic treat- ment, the two roots would have been apparent and the ensuing complications could have been avoided. As Grossman (18) stated, the radiograph "has been an invaluable boon to mankind, giving him a sixth sense to penetrate into the otherwise unknowable."

Dr. Barkhordar is assistant professor and Dr. Nguyen is clinical professor and chairman, Department of Restorative Dentistry, Division of Endodontics, University of California, San Francisco, CA.

Canine with Two Roots 227

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