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CASE REPORT
Year : 2020  |  Volume : 10  |  Issue : 3  |  Page : 271-273

Endodontic management of permanent mandibular canine with Type II canal configuration using cone-beam computed tomography. A Case report


1 Department of Endodontic, Riyadh Elm University, Riyadh, Kingdom of Saudi Arabia
2 Ministry of Health, Riyadh, Kingdom of Saudi Arabia

Date of Submission27-Jun-2019
Date of Acceptance08-Aug-2019
Date of Web Publication27-Aug-2020

Correspondence Address:
Dr. Hadi Rajeh Alfahadi
Department of Endodontic, Riyadh Elm University, P. O. Box: 84891, Riyadh 11681
Kingdom of Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sej.sej_100_19

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  Abstract 


Mandibular canines, in most cases, have one root and one canal. Some investigators reported a morphological variation in mandibular canals. This report documented a case of mandibular canine of a healthy 53-year-old female patient referred for evaluation of deep caries located in the buccocervical region of the crown, which had reached the pulp chamber. Cone beam computed tomography revealed one root with two canals (Vertucci Type II). A diagnosis of symptomatic irreversible pulpitis and asymptomatic apical periodontitis was established, and nonsurgical root canal treatment was performed with the help of dental operating microscope. The use of good diagnostic tools improves the accuracy of the diagnosis and the success of the treatment.

Keywords: Anatomical variations, cone-beam computed tomography, mandibular canine, root canal treatment, type II root canal configuration


How to cite this article:
Alfahadi HR, Alghamdi AM. Endodontic management of permanent mandibular canine with Type II canal configuration using cone-beam computed tomography. A Case report. Saudi Endod J 2020;10:271-3

How to cite this URL:
Alfahadi HR, Alghamdi AM. Endodontic management of permanent mandibular canine with Type II canal configuration using cone-beam computed tomography. A Case report. Saudi Endod J [serial online] 2020 [cited 2020 Oct 31];10:271-3. Available from: https://www.saudiendodj.com/text.asp?2020/10/3/271/293563




  Introduction Top


Elimination of infection from the root canal system and prevention of reinfection is the aim of successful endodontic treatment.[1] One of the main reasons for the failure of root canal therapy is a lack of knowledge of pulp cavity anatomy and failure to negotiate and obturate the canals in its entirety.[2] To avoid these failures, the dentist must consider the anatomy of the tooth before starting the treatment.

In general, permanent mandibular canines usually have a single root and a single root canal.[3],[4],[5],[6],[7] Several reports of anatomical variations of mandibular canine have been reported in the literature. Single-rooted permanent mandibular canine with two root canals is considered an unusual condition.[4],[5],[6],[7]

Cone-beam computed tomography (CBCT) is an advanced practical tool for noninvasive and three-dimensional (3D) reconstruction imaging. It is a more accurate diagnostic tool for an effective assessment of root canal morphology; accurate diagnosis determines the root length, number of roots, curvatures, and bifurcations in both sagittal and axial planes.[8],[9]

This case report describes an endodontic treatment of permanent mandibular canine with two root canals in one root.


  Case Report Top


A 53-year-old Saudi female patient was referred to the Endodontic Clinics in Dental Hospital of Riyadh Elm University, Riyadh, Saudi Arabia, by a prosthodontics postgraduate resident for the evaluation of tooth # 43 (right mandibular canine). She had no history of systemic or allergy problems. Clinical examination revealed caries located in the buccocervical region of the crown, which had reached the pulp chamber. The tooth responded to the sensitivity test and was not tender to percussion or palpation. Radiographic evaluation revealed normal periodontium and presence of more than one root canal [Figure 1]a.
Figure 1: Preoperative radiograph tooth #43 (a) cone-beam computed tomography of tooth #34 with type II root canal configuration, the axial plane (b), the cross-sectional plane (c), working length determination (d), master apical cones (e), and postoperative radiograph (f)

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CBCT was requested to confirm the number of roots and canals of the tooth using 3D-Accuitomo scanner with Viewer Plus software (J. Morita, Kyoto, Japan). A one root with two canals “one buccal and one lingual” was found [Figure 1]b and [Figure 1]c. The two canals joined in one apex that represents Vertucci Type II (1984).

A diagnosis of symptomatic irreversible pulpitis and asymptomatic apical periodontitis was established, and nonsurgical root canal treatment was planned. Local anesthesia using 2% lidocaine and 1:100,000 epinephrine was administered then the tooth was isolated with dental rubber dam. With the aid of magnification dental operating microscope (Global Dental Microscopes, Global Surgical Corporation, U.S.A), the decayed tissue was removed, and the roof of the pulp chamber and the lingual cervical ridge were eliminated to obtain access to search for the two canals. Two separated canal orifices, one buccally and one lingually, were found. The access cavity outline was extended buccolingual to establish straight-line access. Both canals were explored with a size #15K hand file then the cervical third of each canal was flared carefully with #1 and #2 Gates Glidden bur. The working length was determined with a radiograph. The X-ray cone was mesial shifted to identify the two canals and was corroborated with an electronic apex locator, Root ZX II (J. Morita, Tokyo, Japan) [Figure 1]d.

Cleaning and shaping of the apical thirds was performed with X1, X2, and X3 ProTaper rotary files (ProTaper Next, Dentsply, Maillefer, Ballaigues, Switzerland). Canals were irrigated with 2.5% sodium hypochlorite followed by 17% ethylenediaminetetraacetic acid during instrumentation then dried with paper points. The canals were filled with matching gutta-percha cone and AH-Plus resin-based sealer (Dentsply, Dentsply, Germany). The access cavity was sealed with Coltosol temporary filling material (Coltene, Switzerland), and the patient was referred for the final restoration [Figure 1]e and [Figure 1]f.


  Discussion Top


Different techniques such as clearing, tooth sectioning, conventional radiographs, and CBCT have been used to study the morphology of mandibular canine teeth.

Clearing and ground sectioning of the teeth is a laboratory technique that helps in studying the root canal morphology of human teeth.[4],[5],[6],[10],[11],[12] It is an excellent simple and effective educational tool where an image of 3D object “tooth” can be viewed.

Conventional radiograph is one of the important tools commonly used in daily practice that helps endodontist to evaluate teeth before starting root canal treatment. Periapical radiographs of different angles are necessary to detect any morphological variations of teeth.[3],[13] However, CBCT had the capability of providing images with high diagnostic quality that has shorter scanning times and lower dosages in comparing to the conventional computed tomography scans. It is a noninvasive 3D-reconstruction imaging used as a practical tool in endodontic practice.[14]

The use of CBCT tools to study the root canal morphology of mandibular canine was reported in few studies. The prevalence of having Type II root canal configuration viewed by CBCT was reported to be 0.72%–10.3%.[7],[9],[15],[16],[17]

CBCT was used in the current case to confirm the number of roots and canals. Using 3D-Accuitomo scanner with Viewer Plus software produced the smallest field of CBCT view images as well as reduction of the radiation dosage.[18] The cross-section and axial view were very helpful in confirming the presence of two root canals. In addition, the use of dental operating microscope enhanced the final results of the root canal treatment as it helps in avoiding mishaps during the location of the orifices of the two canals due to adequate illumination and magnification.[19]

Root canal morphology of human teeth varies according to ethnicity even within the same population. This might affect the perception of the clinician for the suspected root canal morphology.[20]

The present case was of Saudi female patient. A similar case of male Saudi patient was reported by Alenezi and Al-Hawwas,[21] Al-Dahman et al.,[7] who investigated the root canal morphology of mandibular canines in a Saudi subpopulation using CBCT. One root was observed in 99.8% of the evaluated images with different canal configurations was detected. The further added that the presence of two canals was more frequent in men than in women.


  Conclusion Top


Thorough knowledge of anatomical variations of root canal morphology as well as using CBCT and dental operating microscope is always essential for effective endodontic cases management.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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Vertucci FJ. Root canal anatomy of the human permanent teeth. Oral Surg Oral Med Oral Pathol 1984;58:589-99.  Back to cited text no. 4
    
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Aminsobhani M, Sadegh M, Meraji N, Razmi H, Kharazifard MJ. Evaluation of the root and canal morphology of mandibular permanent anterior teeth in an Iranian population by cone-beam computed tomography. J Dent (Tehran) 2013;10:358-66.  Back to cited text no. 15
    
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Ali AS, Fteita D, Kulmala J. Comparison of physical quality assurance between scanora 3D and 3D accuitomo 80 dental CT scanners. Libyan J Med 2015;10:28038.  Back to cited text no. 18
    
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Alrejaie M, Ibrahim NM, Malur MH, AlFouzan K. The use of dental operating microscopes by endodontists in the Middle East: A report based on a questionnaire. Saudi Endod J 2015;5:134-7.  Back to cited text no. 19
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Martins JN, Gu Y, Marques D, Francisco H, Caramês J. Differences on the root and root canal morphologies between Asian and white ethnic groups analyzed by cone-beam computed tomography. J Endod 2018;44:1096-104.  Back to cited text no. 20
    
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  [Full text]  


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