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JOURNALOF 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 raices. El fracaso en el reconocimiento de esta anomalia probablemente contribuyb a una perforacion
previa en la furacion. El tratamiento quir0rgico posterior 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 aberrations. There have been many reports concerning descriptions 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 mandibular 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 canines with two canals, while Green (12) claimed a frequency of 19.3%. However, aberrations of maxillary
anterior teeth are less frequently reported in the literature. 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. Recently, Blaney etal. (16) reported a case of a maxillary

FiG 1. Maxillarycanineidentification.A, Labialviewshowingposition


of maxillary left canine. B, Incisal view of maxillaryleft 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 treatment for the chief complaint of increased soreness in
224

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). Roentgenograms 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 calcification of both root canals, with no apparent periapical 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 calcified 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 Pathology 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

Canine with Two Roots

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 revealed satisfactory healing with no apparent radiographic 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 obvious that this maxillary canine had an unusual configuration. The two roots are clearly visible on the radiographs. If good diagnostic radiographs had been taken
at different angles before the original endodontic treatment, 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.

227

References
1. Grossman LI. Endodontic practice. 9th ed. Philadelphia: Lea & Febiger,
1978:275.
2. Croft TP, Jackson RN, Chen E. Fusion and gemination in one dental
arch: report of a case. J Dent Child 1981 ;48:297-9.
3. Brook AH, Winter GB. A retrospective study of "geminated" and "fused"
teeth in children. Br Dent J 1970;129:123-30.
4. Clem WH, Natkin E. Treatment of the fused tooth: report of a case. Oral
Surg 1966;21:365-70.
5. Tagger M. Tooth gemination treated by endodontic therapy. J Endodon
1975;1:181-4.
6. Mehlman ES. Management of totally fused central and lateral incisor
with internal resorption perforating the lateral aspect of the tooth. J Endodon
1978;4:189-91.
7. Cams EJ, Skidmore AE. Configurations and deviations of root canals of
maxillary first premolars. Oral Surg 1973;36:880-6.
8. Wheeler RC. Dental anatomy, physiology and occlusion. 5th ed. Philadelphia: WB Saunders Co., 1974:195-207.
9. Barrett MT. The internal anatomy of the teeth with special reference to
the pulp with its branches. Dent Cosmos 1925;67:581-92.
10. Laws AJ. Prevalence of canal irreguladties in mandibular incisiors: a
radiographic study. NZ Dent J 1971 ;67:181-6.
11. Mededa MC, Hetem S. Incidence of bifurcations in mandibular incisors.
Oral Surg 1973;36:589-91.
12. Green D. Double canals in single roots. Oral Surg 1973;35:689-96.
13. Vertucci FJ. Root canal anatomy of the mandibular antedor teeth. J Am
Dent Assoc 1974;89:369-71.
14. Pineda F, Kuttler Y. Mesiodistal and bucco lingual roentgenographic
investigation of 7275 root canals. Oral Surg 1972;33:101-10.
15. Christie WH, Peikoff MD, Acheson DW. Endodontic treatment of two
maxillary lateral incisors with anomalous root formation. J Endodon
1981 ;7:528-34.
16. Blaney TD, Hartwelt GR, Beilizzi R. Endodontic management of a fused
tooth: a case report. J Endodon 1982;8:227-30.
17. Zilllich RM, Ash JL, Corcoran JF. Maxillary lateral incisor with two roots
and dens formation: a case report.J Endodon 1983;9:143-4.
18. Grossman LI. Endodontic practice. 9th ed. Philadelphia: Les & Febiger,
1978:10.