|Year : 2016 | Volume
| Issue : 2 | Page : 98-100
Permanent mandibular canine with two roots and two root canals: Two case reports
Mohammad Ahmad Alenezi1, Abdullah Yousef Al-Hawwas2
1 Department of Endodontic, Riyadh Colleges of Dentistry and Pharmacy, Riyadh, Kingdom of Saudi Arabia; Department of Dental, Ministry of health, Kuwait
2 Department of Dental, King Saud University Medical City, Riyadh, Kingdom of Saudi Arabia
|Date of Web Publication||18-Apr-2016|
Mohammad Ahmad Alenezi
Department of Endodontic, Riyadh Colleges of Dentistry and Pharmacy, P. O. Box: 84891, Riyadh 11681
Source of Support: None, Conflict of Interest: None
The knowledge of root canal system of different human teeth is a "road map" for the successful root canal treatment. Mandibular canine usually contains one root with a single root canal. Two-rooted mandibular canine is rare. This paper describes two cases of root canal therapy of permanent mandibular canine with two root canals and one apical foramen (Type II) in one root and canine with two separated roots. The clinicians must always suspect anatomical varieties and use all the available tools to diagnose and manage their cases.
Keywords: Anatomic variation, mandibular canine, root canal morphology, root canal treatment
|How to cite this article:|
Alenezi MA, Al-Hawwas AY. Permanent mandibular canine with two roots and two root canals: Two case reports. Saudi Endod J 2016;6:98-100
| Introduction|| |
The aim of endodontic treatment is to eliminate microorganism infection from the root canal system and prevent reinfection. Failure of incomplete root canal treatment (RCT) may lead to postoperative disease, pain, and complications. ,, Therefore, endodontists should be aware of any variations or additional canals to improve the predictability of root canal therapy. 
Usually, mandibular canine has one root with a single root canal. ,, The anatomical variations associated with permanent mandibular canines have been reported by several investigators. Pineda and Kuttler,  Green,  and Vertucci  reported that the occurrence of mandibular canines with one root and two root canals is approximately 15%. At the same time, the incidence of mandibular canines having two roots and two canals was reported to be up to 5%. ,
The following clinical case reports illustrate the nonsurgical endodontic treatment of two mandibular canines with two roots and two root canals.
| Case reports|| |
A 62-year-old Saudi man with a controlled hypertension and diabetes mellitus Type II reported to endodontic postgraduate clinics of Riyadh College's Dental Hospital, Riyadh, Saudi Arabia for the nonsurgical endodontic treatment of mandibular left canine (number 33). The chief complaint was to complete the RCT that was started by general dentist a week ago. The tooth has no coronal restoration and was not tender to percussion or palpation. Radiographic examination revealed unclear root canal space and apical rarefaction [Figure 1]a. A diagnosis of previously initiated therapy and asymptomatic apical periodontitis was established.
|Figure 1: (a) Preoperative radiograph of mandibular canine. (b) Working length showing two canals joining in one apex. (c) Obturation|
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Local anesthesia without epinephrine was introduced through infiltration, and then the rubber dam was placed for isolation. After removal of caries with large low-speed round bur, the pulpal floor was carefully examined with dental operating microscope (DOM) (Global Dental Microscopes, Global Surgical Corporation, USA). Two separate buccal and lingual orifices were identified. The access cavity outline was extended buccolingual to establish straight-line access then the working length was established using electronic apex locator, Root ZX II (J. Morita, Tokyo, Japan), and confirmed radiographically [Figure 1]b.
The canals were prepared with ProFile 0.04 files rotary system (Dentsply, Maillefer, Ballaigues, Switzerland) until reached file number 45. Copious irrigation with 2.5% sodium hypochlorite (NaOCl) followed by 17% ethylenediaminetetraacetic acid (EDTA) was carried out during the instrumentation phase. Paper points were used to dry the root canals, and then obturation was achieved by matching Gutta-percha cones and AH-Plus Sealer (Dentsply Maillefer, Ballaigues, Switzerland). The access cavity was sealed with Coltosol temporary filling material (Coltosol® F, Coltene, Switzerland), and the patient was referred to receive final restoration [Figure 1]c.
A 22-year-old Saudi woman presented for nonsurgical endodontic treatment of mandibular left canine (number 33). Her chief complaint was "I feel pain on my tooth." A review of her medical history indicated that she was in relatively good health. The tooth did not respond to sensibility test and was sensitive to percussion and palpation. Radiographic examination revealed two separate roots with slight widening of apical periodontal ligament [Figure 2]a. A diagnosis of necrotic pulp and symptomatic apical periodontitis was established.
Infiltration local anesthesia with epinephrine was administrated, and isolation was achieved through rubber dam placement. The access cavity was carried out, and the outline extended buccolingually to accommodate the buccal and lingual root canal. The pulpal floor was carefully examined with DOM, and then the working length was established using electronic apex locator, Root ZX II (J. Morita, Tokyo, Japan).
Instrumentation was performed by using K3 0.04 Rotary File System (Kerr Corporation, USA) until reached file number 40. Copious irrigation with 2.5% sodium hypochlorite NaOCl and 17% EDTA was carried out during all the instrumentation phases. Before obturation, the root canals which were dried by paper point, and the obturation was achieved by matching Gutta-percha cones and AH-Plus Sealer. The access opening was filled with Coltosol temporary filling material, and the patient was referred for final restoration [Figure 2]b.
|Figure 2: (a) Periapical radiograph showing bifid roots of mandibular canine. (b) Obturation|
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| Discussion|| |
Careful examination of the initial radiograph is extremely important. It allows the identification of multiple roots, root canals, and anatomical variations. The anatomical variations related to mandibular canine must be identified when this tooth is involved in an endodontic diagnosis or treatment planning, In addition, good access opening will help to detect all canals opening.
Mandibular canines having one root with single canal are common, however, two root canals, ,,,,, and in some extraordinary cases, there may be one or two roots with three root canals ,, has been reported.
Two mandibular canines were reported in the present case. One tooth has single root, and the other one has two roots. The incidence of two root canals in single-rooted mandibular canine teeth has been reported to be up to 6.25%.  Vertucci observed only 6 teeth with Type IV canal configuration (two separate and distinct canals from the pulp chamber to the apex) and 14% of mandibular canine having Type II canals  in mandibular canine.
Two clinical cases of Saudi female patients with two roots and two canals were reported in a mandibular canine. , One of the patients in this report was female. The incidence of two canals in mandibular canine was reported in female more than male.  By all the odds, careful interpretation of conventional periapical radiographs taken at more than one angle is necessary to detect variations of teeth morphological. , Recently, advanced diagnostic radiographic tools such as cone-beam computed tomography (CBCT) are very helpful to diagnose morphological variations if conventional radiographic techniques provide lack information and more details are required. 
Moreover, use of magnification tools (magnification loupe or DOM), the use of fiber optics, and sodium hypochlorite NaOCl bubble technique might help to locate any additional root canals.  DOM was used in the present cases. It helps to detect extra canals.  Unfortunately, some endodontists who are using the DOM in their dental clinics are not using it as often as they anticipated. 
| Conclusion|| |
Although the probability of permanent mandibular canine has extra roots and root canals are infrequent, the clinicians should suspect any anatomical variations in these teeth. Careful interpretation of conventional radiographs with different angulations and use of advanced radiographic tools such as CBCT, appropriate access cavity design to visualize the entire pulp chamber floor as well as the use of magnifying tools are helpful to evaluate complex root canal anatomy.
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Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]