Research Article

Endodontic Treatment of Mandibular Canine

with Two Root Canals: A Case Report
Aditi Jain1
Abstract
The main reason for unfavorable outcome in endodontic treatment of mandibular anterior is the inability
to detect the presence of second canal. Pain even after extirpation of complete pulp tissue from root
canal of vital teeth is the main indication of hidden canals.

Keywords: Two root canals, Missed canals, Canine

Introduction
Additional root or root canals if not identified are a major reason behind failure of this treatment. Incomplete removal of
all the irritants from the pulp space may increase the possibility of treatment failure. The principle reason for failure in
root canal treatment of mandibular anteriors is the inability to recognize the presence of a second root canal, which can
then not be prepared and obturated during treatment. Complete debridement and obturation of the root canal system
is a key component for successful endodontic treatment. The operator should therefore have exhaustive learning of
the root canal morphology of the teeth. The mandibular anterior teeth are not frequently cariously involved, but rather
there are numerous situations where these teeth require endodontic treatment. It was initially believed that mandibular
incisors generally have only one root canal.1 However, studies have revealed high variety of root canal morphology
among mandibular anterior teeth.2-6 The study completed by Bellizzi et al. in 1965 demonstrated high predominance of
two canals in the mandibular incisors,5 which stimulated further researches on the canal configuration of other teeth,
especially ones with generally low endodontic success rate. These reviews, did on various populations with different
techniques2,7-12 demonstrated that the root canal morphology varies with race, sex, and age.3,6 The predominance of two
canaled mandibular incisors has been accounted to be 11% in UK and 70% in Turkey.6,13,14 The presence of the second
canal in mandibular canines has been reported to be 7.8% in a Brazilian population and 38% in a Turkish population.

Case Report
A 24-year-old male patient reported with chief complaint of pain in the mandibular anterior region since 1 month. The
tooth was tender on percussion. In view of clinical and radiographic findings, diagnosis of irreversible pulpitis with acute
apical periodontitis was made and endodontic therapy was anticipated for the same (Fig. 1). Under optra dam and
local infiltration of mandibular anteriors, proper access opening was made and enlarged buccolingually and extended
into cingulum gingivally, which revealed the presence of a lingual canal. The patency was checked using a No. 10 K file.
Working length was dictated by placing a No. 20 K file in the buccal canal and No. 15 H file in the lingual canal, using
digital radiography. The presence of separate canals was confirmed using different angulations (Fig. 2). Cleaning and
shaping was carried out using conventional hand instruments. 2.5% of sodium hypochlorite and 17% EDTA were utilized
for irrigation. The canals were rinsed with normal saline after each instrument change. The root canals were then filled
with gutta-percha using the lateral condensation method and Apexit (VOCO GmbH, Cuxhaven, Germany) as the sealer
(Fig. 4). The access cavities were restored with glass ionomer cement. Radiographs were taken with multiple angulations
(20 degree right and 30 degree left horizontal beam angulation) for better identification of two canals5 with follow up
radiograph of 3 months, 6 months, and 9 months (Fig. 5).

1
MDS SR. Lecturer, Department of Conservative Dentistry and Endodontics, Maitri College of Dentistry and Research centre, Anjora
,Durg (Chhattisgarh).

E-mail Id: aditijain300789@gmail.com

How to cite this article: Jain A. Endodontic Treatment of Mandibular Canine with Two Root Canals: A Case Report. J Adv Res Dent
Oral Health 2017; 2(1&2): 1-4.

ISSN: 2456-141X

© ADR Journals 2017. All Rights Reserved.

Jain A J. Adv. Res. Dent. Oral Health 2017; 2(1&2)

Figure 1.Preoperative Radiograph

Figure 2.Working Length Determination

Figure 3.Mastercone Radiograph

ISSN: 2456-141X 2
J. Adv. Res. Dent. Oral Health 2017; 2(1&2) Jain A

Figure 4.Post-Operative Radiograph Showing Obturation in Two Separate

Canals in Mandibular Canine

Figure 5.Follow up Radiograph of 3 Months, 6 Months and 9 Months

Discussion uncovered the missed lingual canals in mandibular canine.

A well-designed access preparation is essential for a
good endodontic outcome. Without adequate access,
instruments and materials become difficult to handle
properly in the highly complex and variable root canal
system. Appropriate access cavity preparation provides
straight or direct line access to the apical foramina or at
least to the initial curvature of canal to find all root canal
orifices and it also conserves sound tooth structure.6
Mandibular anteriors because of their small size and
internal anatomy may be most difficult access cavities
to prepare. Complete removal of the lingual shoulder is
critical, because these teeth often have two canals that are
buccolingually situated and lingual canal regularly is missed.
To avoid missing this canal, the clinician ought to extend
the access preparation well into cingulum gingivally, which,
if present, is found directly underneath it.6 When there are
two canals, the buccal canal is the easiest to find and is for
the most part straighter than the lingual canal, which is
frequently shielded by lingual shelf.7 In this case, extension
of the access opening lingually underneath the cingulum
One of the primary explanations behind endodontic
treatment failure in mandibular incisor teeth is the inability
to locate, debride, and obturate the missed lingual canal.15,16
Immediate relief of pain after location and debridement of
second canal affirmed the reason of pain to be the missed
lingual canals.
Thus, careful interpretation of the radiographic feature
taken from various angles should be done before beginning
root canal treatment. One must be cautious while access
opening, and initial buccolingual widening of mandibular
incisors, and gingival extension beneath the cingulum
must be made to scan for a possible second canal lingually.
The percentage rates of two root canals (type vertucci IV)
with discrete apical foramina in the mandibular central
and lateral incisors are 3% and 2% respectively and in the
canines it is 6%.17
Conclusion
The primary reason behind failure of endodontic treatment

3 ISSN: 2456-141X
Jain A
of mandibular canine can be because of the failure to
recognize and treat second root canal, generally lingual
canal. Thus, careful interpretation of radiographs taken
from various angulations is essential. Practice of extension
of access cavity buccolingually and gingivally underneath
cingulum will help to detect extra lingual canal, if present,
in each mandibular canine.
Conflict of Interest: None
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Date of Submission: 2017-06-20
Date of Acceptance: 2017-07-05
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